X-ray limitations

Diagnostic errors involving imaging include not ordering appropriate imaging, incorrectly reading imaging, and incorrectly applying the results of diagnostic imaging due to its intrinsic limitations. We can order the right image and correctly read it, but if we don’t consider the inherent test characteristics we can still make a diagnostic error. This especially applies to…

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 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…

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…

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…

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…

missed PE

Pulmonary embolism is both over-investigated in young people and missed in elderly people and those with comorbid conditions, and those with PE can have a benign or complicated course. I’ve shared some bounceback cases on PE, and here are a few studies to keep in mind to better assess and manage patients with potential PE…