Impact of diagnostic errors on adverse outcomes: learning from emergency department revisits with repeat CT or MRI

Area of Science:

• Medical Imaging
• Patient Safety
• Diagnostic Accuracy

Background:

• Investigating diagnostic errors and their link to adverse outcomes (AOs) in emergency department (ED) patients requiring repeat imaging within 7 days.
• Understanding the impact of diagnostic errors on patient safety during revisits.

Purpose of the Study:

• To determine the association between diagnostic errors in initial imaging studies and adverse outcomes in patients undergoing repeat imaging in the ED.
• To identify specific factors contributing to adverse outcomes in early versus late revisits.

Main Methods:

• Retrospective analysis of 1054 repeat imaging revisits (RVRIs) within 7 days, from 2005 to 2015.
• Categorization of RVRIs into early (≤72 hours) and late (>72 hours to 7 days) based on revisit timing.
• Multivariable logistic regression analysis to assess risk factors for adverse outcomes.

Main Results:

• The adverse outcome rate was significantly higher in the diagnostic error group (33.3%) compared to the non-error group (14.8%).
• Early revisits within 72 hours with diagnostic errors had the highest adverse outcome rate (36.2%).
• Radiologic errors were significant contributors to adverse outcomes in total, early, and late revisits, with clinician errors also contributing to early revisits.

Conclusions:

• Diagnostic errors in initial imaging studies are strongly associated with increased adverse outcomes in emergency department repeat imaging revisits.
• Addressing diagnostic errors, particularly in early revisits, is crucial for improving patient safety in the ED.