A new report issued by the Agency for Healthcare Research and Quality (AHRQ), dated December 15, 2022, alleges: “About 5.7% of patients seen in the emergency department (“ED”) receive an incorrect diagnosis with about 2.0% experiencing an adverse event because of the incorrect diagnosis; some of these adverse events are serious (~0.3%). This translates to about 1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death.” The authors describe these rates as similar to those seen in primary care and inpatient hospital settings.
The report, intended to provide a systematic review of the number of misdiagnoses in emergency rooms as part of AHRQ’s Effective Health Care Program, included data from 279 studies. The authors identified the five most frequently misdiagnosed conditions in the ED as stroke, myocardial infarction, aortic aneurysm and dissection, spinal cord compression and injury, and venous thromboembolism. On a local level, the authors estimate that an average ED with approximately 25,000 visits per year could experience 1400 diagnostic errors, 500 diagnostic adverse events, and 75 serious harms, including 50 deaths. However, the authors note that the overall error and harm rates were based on three studies from outside the United States (Canada, Spain, and Switzerland) and that only two of these were used to estimate harms.
Nine top professional emergency medicine organizations in the United States, including the American College of Emergency Physicians (ACEP), have jointly issued a letter expressing concerns about the misleading and incomplete nature of the AHRQ’s report. And at least one emergency physician at Yale recently published an op-ed piece in The Wall Street Journal, stating the “[inaccurate] estimates undermine the patient-physician relationship and the dwindling trust in public-health reporting.”
The concerns of the emergency medicine organizations fell into four categories: misrepresentation of the practice and nature of emergency medicine; applicability of references cited; inaccurate interpretation of malpractice data; and the reporting of a single overall diagnostic error rate of 5.7% in EDs. One major criticism of the report stemmed from the fact the report’s conclusion that 250,000 people die annually in American EDs was extrapolated from a single study based on one death that occurred in Canada in 2004. This single death was then misused to estimate the death rate across the United States. This conclusion would place ED misdiagnoses in the top five causes of death in the United States, which there is no evidence to support. Moreover, the studies cited in the report did not mention whether patients’ final diagnoses were apparent on admission to the ED.
The potential repercussions of the AHRQ’s report are significant. First, the report could be harmful to patients by instilling fear and doubt about the ability of emergency physicians to diagnose and treat. Second, it could scare patients away from seeking care when they need it most in emergency situations. Third, the practice of emergency medicine could see more malpractice claims because of a distrust in the patient-physician relationship stemming from sensationalized headlines like the ones contained in the report. In the end, however, the emergency medicine organizations emphasize the AHRQ report is simply not an accurate reflection of the technology and skill set that current emergency medicine practice offers in 2023.
 To read the full report, Diagnostic Errors in the Emergency Department: A Systematic Review, visit: https://effectivehealthcare.ahrq.gov/products/diagnostic-errors-emergency/research#field_report_title_1.
 The Multi-Organizational Letter Regarding AHRQ Report on Diagnostic Errors in the Emergency Department can be found here: https://www.acep.org/globalassets/sites/acep/media/medical-legal/multi-organizational-letter-regarding-ahrq-report-on-diagnostic-errors-in-the-emergency-department—december-14-2022.pdf.
 See “A Study Sounds a False Alarm About America’s Emergency Rooms” by Dr. Kristen Panthagani: https://www.wsj.com/articles/false-alarm-about-emergency-rooms-ahrq-physicians-er-misdiagnoses-mortality-rate-us-canada-trust-11672136943.