Abstract Details

Title Serious Misdiagnosis-Related Harms Due to Missed Vascular Events in the United States—Incidence, Settings, and Causes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-047

Objective We sought to estimate the US malpractice-based proportion and population-based incidence of missed vascular events, and define the most common settings/causes for these errors.

Background Missed vascular events account for a large fraction of the serious morbidity and mortality. Population-based estimates are lacking.

Design/Methods Cross-sectional study of missed/delayed vascular diagnoses. We analyzed malpractice claims in a national comparative system representing ~30% of US claims (CRICO Strategies 2006-2015 [n=55,377]), and identified cases attributable to vascular diagnostic errors. Annual US incidence for each vascular disease was measured using the Healthcare Cost and Utilization Project’s National Inpatient Sample (2012-2014 [n=21.5M]). Disease-specific diagnostic error and harm rates were estimated from literature. Total serious misdiagnosis-related harms (death or permanent disability) from vascular events were extrapolated to the population-level using the attributable fraction of vascular events in malpractice data. Ranges were calculated as 95% confidence intervals for individual diseases and probabilistic plausible ranges (PPR) for aggregate estimates, using Monte Carlo simulation. Settings/causes were derived from malpractice claims.

Results 11,592 diagnostic error claims were identified (median age 49 51.7% female); 7,379 high-severity claims. Vascular events accounted for 22.8% of high-severity claims (n=1,684/7,379), 22.7% of incident diagnostic errors (533,817/2,351,356; PPR 298,363-667,314), and 17.9% of incident misdiagnosis-related harms (98,922/552,532; PPR 59,885-130,175). Settings were ambulatory clinics (34.3%), emergency departments (31.1%), and inpatient units (34.1%). Top contributing factors were clinical judgment (86%), communication (33%), and documentation (22%). Top vascular conditions (error rate; errors/year) included: stroke (8.7%; 82,832), venous thromboembolism (19.9%; 63,527), arterial thromboembolism (28.2%; 48,886), myocardial infarction (2.2%; 27,458), and aortic aneurysm/dissection (9.0%; 26,719). The top five accounted for 46.7% of vascular-event errors (249,422/533,817) and 79.8% of vascular-event harms (78,950/98,922).

Conclusions About 100,000 Americans die or are permanently disabled from missed vascular events annually. Five vascular diseases account for ~80% of serious misdiagnosis-related harms. Initial efforts to improve diagnosis should focus on these conditions.

Authors/Disclosures
Ali Saber Tehrani, MD (Johns Hopkins University School of Medicine) PRESENTER	Dr. Saber Tehrani has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Mehdi Fanai, MD	No disclosure on file
	No disclosure on file
David E. Newman-Toker, MD, PhD, FAAN (Johns Hopkins Unversity School of Medicine, Dept of Neurology)	The institution of Dr. Newman-Toker has received research support from NIH, AHRQ, AHA, Moore Foundation. Dr. Newman-Toker has received intellectual property interests from a discovery or technology relating to health care.

��ɫ��

��ɫ��