Characteristics and Trends of Medical Diagnostic Errors in the United States
Authors: Ao Hei Sio , Matthews Tracy 
Published: December 2024

Background

Diagnostic errors could lead to severe harm resulting in permanent disability or death. Previous studies suggest that diagnostic errors are prevalent in the United States. A better understanding of the characteristics and trends of diagnostic errors would help identify priority areas for improving patient safety. This quantitative descriptive research study aims to explore the characteristics and trends of diagnostic errors in the United States.

Methods

This study analyzed 226,781 paid malpractice claims data (1999–2018) included in the National Practitioner Data Bank Public Use Data File using IBM SPSS Statistics. Descriptive statistics were used to summarize and describe the data of variables of interest. Normality test, chi-square tests, and Mann-Whitney U tests were also performed for data analysis.

Results

This study found that diagnosis-related allegations accounted for a high proportion of malpractice allegations and payment during the 20-year period, and many of them were linked to cases associated with disability or death. The leading specific malpractice allegations were failure to diagnose, delay in diagnosis, wrong or misdiagnosis, and failure to order appropriate test. The results showed that some sample characteristics, including patient gender, patient type, patient age group, and practitioner age group, were statistically significantly associated with diagnosis-related allegations linked to disability/death outcome or higher malpractice payment. While the overall trends for diagnosis-related allegations were downwards, the overall trends were upwards for diagnosis-related allegations associated with inpatients. 

Conclusion

This study suggests that reducing diagnostic errors remains a priority area for improving patient safety.

Plain Language Summary

In medicine, diagnosing a health problem is only the first step. In order to treat the illness effectively, you must understand what’s causing it. So it is with medical diagnostic errors; we know they are prevalent in the United States and can contribute to significant harm, as delayed or incorrect diagnoses can result in permanent disability or even death. But why do diagnostic errors continue to happen? To begin to answer this question, researchers looked at data about paid malpractice claims from 1999 to 2018 to identify what kinds of diagnostic errors are occurring and their frequency.

In studying 226,718 reports in the National Practitioner Data Bank Public Use Data File, the authors found that diagnosis-related allegations accounted for the second-highest proportion of malpractice allegations, many of which were linked to disability or death. The top malpractice allegations included failure to diagnose, delay in diagnosis, wrong or misdiagnosis, and failure to order the appropriate test. Male patients were more likely to encounter diagnosis-related incidents, and the overall trend of diagnosis-related allegations associated with inpatients increased over the 20 years in the study. This analysis sheds some light on the characteristics and trends of diagnostic errors, which may help delve into the causes of diagnostic errors and the development of effective interventions to improve patient safety.