ECG

missed ACS

Missed ACS is a common source of medico-legal cases. In the Canadian Medical Protective Association’s 2010 article Delay in diagnosis of ACS, they identified 292 ACS related medico-legal cases in the previous decade, and identified common problems: “incomplete history, delay in testing, incomplete testing, and misinterpretation of diagnostic tests.   What’s the scale of the…

snowboarders-fracture

missed fractures

Missed fractures consistently rank in the top list of medico-legal errors in the emergency department.   A few articles on the incidence of missed fractures Diagnostic errors in an accident and emergency department. Emerg Med J 2001;18:263-269. In an analysis of 953 diagnostic errors on injured patients, diagnostic errors included:  79% fractures, 2% dislocations, 2%…

AAA

missed AAA

As William Osler said, “There is no disease more conducive to clinical humility than aneurysm of the aorta.” Ruptured AAA classically presents as abdominal pain radiating to the back, shock and a pulsatile abdominal mass. But like all “classic” presentations this occurs in a minority of cases and there is a high misdiagnosis or delayed…

dx

Emergency medicine diagnoses

Patients can present to the emergency department with any diagnosis, but as emergency physicians we are focused on a finite subset of conditions that require emergent diagnosis and treatment. There are many complex diagnoses we can’t make with the tests at our disposal (internal medicine diagnoses like celiac, Wegener’s, etc), and there are many benign…

misdiagnosed

Missed diagnoses in patients admitted from the Emergency Department

There are patterns diagnoses for patients discharged from the Emergency Department whose were deemed well enough for discharge and whose diagnoses were missed (MI dismissed as GERD, fracture missed on Xray, appy misdiagnosed as gastro). But there are other patterns of diagnoses for patients who are deemed sick enough to require hospitalization, but the reason…

medicolegal

Medico-legal error in the Emergency Department

What can we learn from medico-legal cases about the most common errors in the Emergency Department? Two studies of closed malpractice claims from adult patients highlight the importance of misdiagnosis, especially for MI, fraction, infection and appy: An Epidemiologic Study of Closed Emergency Department Malpractice Claims in a National Database of Physician Malpractice Insurers. Acad…

SAH

missed subarachnoid hemorrhage

Subarachnoid hemorrhage is a classic emergency medicine diagnosis: rare, deadly, and easiest to miss in its early stages when there’s the greatest chance of intervention. A third of SAH die immediately, a third have longterm neurological consquences, and a third make a good recovery–and it’s this last group that has the highest miss rate and…