missed stroke

The diagnosis of stroke remains a challenge, due to overlapping symptoms with other conditions, limitations in diagnostic tests, and lack of awareness of posterior circulation presentation and workup. Below is a brief overview of the rate and risk factors for missed stroke, common stroke mimics and chamelons, and the challenge of diagnosing stroke in patients…

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…

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%…

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…

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…

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…