En español | The critically ill patients in an intensive care unit are the most closely monitored and tested patients in a hospital. Surrounded as they are by doctors, nurses and blinking banks of equipment, one might expect they would receive the very best medical care.
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But not so, according to a recent study by patient safety experts at Johns Hopkins Medicine in Baltimore. Diagnostic errors are common in intensive care units (ICUs), according to study author Bradford Winters, an associate professor of anesthesiology and critical care medicine. He and his colleagues found that more than one-fourth of patients who died in an ICU had at least one missed diagnosis. The study estimates as many as 40,500 ICU adult patients a year die with an unknown medical condition.
Whether physicians' diagnoses were flat-out wrong or they failed to spot life-threatening illnesses, had doctors' diagnoses hit the mark, they would have started treatments that, in many cases, could have saved lives, Winters says. In addition to the deaths, such errors can lead to unnecessary surgeries, lengthy hospital stays and long-term disability in patients who might have otherwise fully recuperated.
In an ICU it's easy to get pulled down the wrong diagnostic path, says Winters. Doctors receive about 7,000 pieces of information a day in this complex, distracting environment. "We're drinking from a fire hose" of information, he says.
Winters and other doctors from around the country gathered recently at a conference at Johns Hopkins aimed at improving patient safety by reducing diagnostic errors.
Diagnostic errors in the ICU are part of a larger problem, according to conference head David Newman-Toker, an associate professor of neurology and otolaryngology at Johns Hopkins. Overall, diagnostic errors result in the death of an estimated 40,000 to 80,000 hospital patients each year.
Misdiagnoses also occur frequently in emergency rooms, where doctors are scrambling to decide whether patients should be admitted to the hospital or sent home. It's "the toughest place to practice medicine," he says, and, "as a consequence, we don't perform that well."
Just five conditions account for more than one-third of all missed diagnoses in the ICU. Read below for signs and symptoms of the conditions, the illnesses doctors often confuse them with and the tests physicians use to diagnose them accurately.
1. Heart attack
Death of — or damage to — part of the heart muscle, usually after a blood clot reduces or stops blood flow.
Symptoms: Classic symptoms include chest pain, shortness of breath, dizziness or light-headedness and breaking out in a cold sweat. Less common symptoms include nausea, vomiting, overwhelming fatigue and pain in the jaw, back, neck or shoulder blades. Women are more likely than men to have these less common symptoms, but men can experience them as well.
Confused with: Doctors may diagnose a heart attack as heartburn, a gallbladder infection or pulmonary embolism. In some cases, symptoms are mild enough that neither doctor nor patient realizes that the patient's symptoms are significant.
Diagnostic tests: Blood tests for heart muscle enzymes (cardiac specific troponin I or troponin T) can reveal whether the heart muscle has been damaged. Generally, the more damage to the heart, the greater the amount of troponin T in the blood. Although patients in the ICU are often connected to heart monitors, a special diagnostic electrocardiogram (EKG) is often required to detect a heart attack.
Treatment: Medications include aspirin and beta-blockers. Doctors also may perform an angioplasty procedure to open blocked arteries. Stents may be placed inside the artery to help keep it open.
Next: Misdiagnosed condition No. 2: Pulmonary embolism. »