Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics

Abstract

Background: An estimated 1.2 million people in the US have an acute myocardial infarction (AMI) each year. An estimated 7% of AMI hospitalizations result in death. Most patients experiencing acute coronary symptoms, such as unstable angina, visit an emergency department (ED). Some patients hospitalized with AMI after a treatand-release ED visit likely represent missed opportunities for correct diagnosis and treatment. The purpose of the present study is to estimate the frequency of missed AMI or its precursors in the ED by examining use of EDs prior to hospitalization for AMI. Methods: We estimated the rate of probable missed diagnoses in EDs in the week before hospitalization for AMI and examined associated factors. We used Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases for 2007 to evaluate missed diagnoses in 111,973 admitted patients aged 18 years and older. Results: We identified missed diagnoses in the ED for 993 of 112,000 patients (0.9% of all AMI admissions). These patients had visited an ED with chest pain or cardiac conditions, were released, and were subsequently admitted for AMI within 7 days. Higher odds of having missed diagnoses were associated with being younger and of Black

Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample

“…Women are also more likely to experience dizziness and headaches of benign cause [37–39], increasing the challenge of differentiating strokes from stroke mimics. Hispanic and non-White patients were more likely to be misdiagnosed, in keeping with prior studies of stroke [31] and myocardial infarction [40]. The causes of this racial disparity are not clear, but some evidence suggests that diagnostic stroke workups are less thorough for Hispanics [41].…”

Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data

“…The method is strongly supported by the fact that the dizziness-stroke dyad has an extensive body of remarkably coherent and consistent scientific literature 2628 that includes chart reviews, 151667 surveys, 6869 cross-sectional health services research studies, 50515670 prospective cohort studies 7172 and SPADE-type studies using look-back 25 and look-forward 21–23 methods. Problems inherent in human chart reviews, particularly hindsight and observer biases, 12–14 and flawed underlying documentation 15 suggest that this is probably not an ideal reference standard for SPADE.…”

Discharge of Non–Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner–Led Chest Pain Clinic

“…40,41 This study safely captured the one per cent late evolving ACS and the mortality rate of 0.4% is good compared to previous studies of low risk patient discharged from a chest pain unit (1.7%) 42 and reflects the current evidence that nurse-led clinics have good outcomes for all-cause mortality 43 evidencing patient safety.…”