Medical Malpractice: What Are the Top 10 Misdiagnosed Conditions in Emergency Rooms?

A 2023 study published by the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services, found that around 5.7% (7.4 million) of emergency room patients in the United States are misdiagnosed. And out of that 7.4 million, around 370,000 patients suffer serious damages, including permanent disability or death, after being misdiagnosed. The misdiagnoses were often caused by inadequate knowledge, skills, or reasoning or when symptoms were mild, transient, or atypical.

This study was performed by researchers at the Johns Hopkins University Evidence-Based Practice Center in Baltimore. After reviewing 279 studies and 19,127 citations, these researchers determined that stroke, myocardial infarction, aortic aneurysm, spinal cord compression, venous thromboembolism, meningitis, sepsis, lung cancer, traumatic brain injury, and arterial thromboembolism were the top 10 conditions with the greatest number of misdiagnosis-related harms.

1. Stroke

Common signs and symptoms of stroke include numbness or weakness, especially on one side of the body, confusion or issues with speaking, vision issues, balance and mobility issues, and severe headaches. The medical world even developed an acronym to help the public understand and recognize the early signs of a stroke: BE FAST (Balance Issues, Eyes, Facial Drooping, Arm or Leg Weakness, Speech Difficulties, and Time to Call 911).

The problem is that some people don’t display these obvious signs. When symptoms are nonspecific, misdiagnoses can happen, and these misdiagnoses can result in permanent disability or even death.

The National Institutes of Health (NIH) even reports that stroke is the most dangerous missed diagnosis, and another study found that “deaths from stroke are attributed to diagnostic error over 30 times more often than deaths from myocardial infarction.” Another 2018 study published by the NIH found that stroke misdiagnoses were common among FAST-negative patients with nonspecific symptoms like dizziness, temporary numbness, and mild headaches.

Additionally, stroke affects women differently than men, and women generally experience worse outcomes than men. In addition to the traditional symptoms associated with stroke, women may experience hiccups, nausea, chest pain, fatigue, shortness of breath, and a higher heart rate, which are nonspecific and easier to misdiagnose.

2. Myocardial Infarction (Heart Attack)

A study published by the Journal of Evidence-Based Medicine found that acute myocardial infarctions, or heart attacks, are frequently misdiagnosed as nonspecific chest pain, gastrointestinal disease, musculoskeletal pain, and arrhythmias. Some of the reported causes of the misdiagnoses were incorrect interpretation of electrocardiogram and failure to order the appropriate diagnostic tests.

Like stroke, there are gender-based differences in the experienced symptoms. The standard symptoms are chest pain, heartburn, indigestion, and sudden dizziness, but women could also experience nausea/vomiting and back or jaw pain. These latter symptoms are so nonspecific that women may not even seek medical attention for them.

The issue is further compounded by the fact that other conditions like indigestion, dehydration, heartburn, panic attacks, and heat strokes also feature similar symptoms, increasing the risk of misdiagnosis should medical care be sought.

3. Aortic Aneurysm & Dissection

Aortic dissection (AD) occurs when the body’s main artery (the aorta) experiences a tear. Stanford Type A is when the tear starts in the upper part of the aorta (considered ascending), while Type B is farther away from the heart on the abdominal aorta (considered descending).

Symptoms usually include sharp chest and belly pain, shortness of breath, lightheadedness, low blood pressure, confusion, and standard stroke symptoms. The issue with aortic dissection is that the diagnosis must be made immediately in case surgery is needed, sometimes resulting in costly and life-threatening misdiagnoses. The symptoms of an aortic dissection can be very similar to acute coronary syndrome, acute stroke, and cardiogenic shock. Studies have even urged healthcare providers to consider aortic dissection “a differential diagnosis in patients with chest pain, back pain, and syncope” and to use imaging early on if AD is suspected.

4. Spinal Cord Compression & Injury

The Annals of Emergency Medicine found that 18 out of 81 individuals (22%) were misdiagnosed with spinal cord compression (SCC) at an urban tertiary care hospital and found that ambulatory dysfunction should be considered an early sign of spinal cord compression to improve diagnostic accuracy.

Anyone can be at risk of SCC—any condition that puts pressure on the spinal cord can cause it, including spinal injuries, rheumatoid arthritis, scoliosis, and even certain infections. The symptoms are nonspecific and include numbness, pain, and weakness, which may also be experienced with pinched nerves, muscle strains, and other neurologic conditions.

If spinal cord compression isn’t treated, it can lead to more severe issues like total paralysis, total incontinence, and sensory loss. Whether it’s a misdiagnosis or a missed diagnosis, the results can be devastating if SCC isn’t treated immediately.

5. Venous Thromboembolism

Venous thromboembolism is the official medical term for a blood clot. This condition is often caused after surgery or if there is any type of injury to the vein. However, certain people may be at an increased risk for blood clots, including women who use hormonal birth control pills. If this condition isn’t treated, it restricts blood flow and oxygen. In worst-case scenarios, that blood clot could break free and block flood flow into the lungs, resulting in serious injury or death. In fact, according to the CDC, nearly 100,000 Americans die of venous thromboembolism annually, some of which could have been prevented.

While there are obvious signs of venous thromboembolism, including swelling, redness, and pain in the veins, this condition can sometimes occur without any symptoms at all, increasing the risk of a missed diagnosis. Furthermore, some of the apparent symptoms of venous thromboembolism can be similar to muscle strains, cramps, and sciatica.

If you’ve recently had surgery, have a family history of blood clots, or have a chronic medical condition, your healthcare provider should be taking steps to monitor and prevent venous thromboembolism.

6. Meningitis & Encephalitis

Meningitis and encephalitis are both conditions that cause inflammation in the brain and central nervous system. Meningitis, if left untreated, can cause stroke, brain damage, hearing loss, and even death. Comparatively, encephalitis isn’t as severe but can still result in long-term injuries.

Encephalitis and meningitis have similar symptoms, although severe headaches, nausea/vomiting, drowsiness, light sensitivity, stiff neck, and rashes are closely associated with meningitis. In contrast, seizures, hallucinations, speech issues, confusion, and mood changes are associated with encephalitis.

This condition is so scary because it’s infectious and can be caused by bacteria, viruses, fungi, or parasites. Individuals who work in high-exposure areas (schools, hospitals, daycares, etc.) and children who haven’t been vaccinated have an increased risk of catching it. Once someone has either condition, it can progress quickly and cause irreversible neurological damage.

If doctors suspect either condition, they’re required to perform a neurological examination, order urine and blood tests, analyze the cerebrospinal fluid, use imaging to identify potential inflammation in the brain, and use EEG to monitor electrical activity in the brain.

7. Sepsis

Sepsis is a severe condition that has to be treated immediately to prevent death. The condition progresses so quickly that it can even result in death after 12 hours. Sepsis can be caused by any bacterial infection that isn’t treated properly, including COVID-19, and those who survive it may experience long-term side effects like hallucinations, panic attacks, insomnia, organ failure, and amputation. Survivors are also more likely to experience sepsis again. Cleveland Clinic even reports that over 50% of sepsis survivors are likely to die within five years.

Symptoms can be nonspecific, including fever, shaking or chills, confusion, sweaty skin, and pain. Some people may also experience rashes, a fast heart rate, and a sepsis rash. Sepsis shares some of these symptoms with other conditions like anemia and heart failure.

Similar to AD, a diagnosis of sepsis must be made quickly, which can increase the risk of a misdiagnosis. Doctors will typically look at your blood pressure and respiratory rate and use the Glasgow coma scale to measure your level of consciousness. Blood, urine, imaging, and blood oxygen level tests may also be ordered. What makes sepsis diagnosis challenging is that it’s often difficult to detect early on, so treatment isn’t provided when it’s most needed. One study published by the National Library of Medicine suggests that multiple visits to outpatient care could be an early warning sign of sepsis.

8. Lung Cancer

According to the CDC, lunger cancer is the third most common type of cancer in the United States, but more people die from lung cancer than any other type of cancer. It’s mostly caused by smoking or exposure to toxic gases like radon. People who have had pneumonia are also at higher risk of developing lung cancer.

In its early stages, it can be difficult to detect, and the symptoms associated with it (chest pain, coughing, wheezing, headache, loss of appetite) are similar to the common cold, asthma, allergies, tuberculosis, and bronchitis. The problem is that it needs to be diagnosed early on because it’s harder to treat as the cancer progresses.

The medical community recommends that people seek a second opinion if they’re diagnosed with lung cancer and always go back to their healthcare provider if their treatment plan isn’t working. Imaging is often used to help diagnose tumors in or around the lung, but biopsies are needed to determine if the tumors are cancerous.

9. Traumatic Brain Injury & Traumatic Intracranial Hemorrhage (Brain Bleeding)

Traumatic brain injuries and brain bleeding can occur after a person receives a significant blow to the head. Causes vary, from sports injuries to motor vehicle accidents to assaults. Brain injuries can be treated, and some mild cases will only affect the brain temporarily, but severe cases can result in death or long-term complications if they’re not treated.

Brain injuries, at their least severe, can cause headaches, nausea, drowsiness, and some sensory issues like light sensitivity or blurred vision, while more severe injuries can cause seizures, persistent headaches, agitation, and even coma. Children are at a higher risk of experiencing long-term complications from a traumatic brain injury because they may not be able to communicate their symptoms in time effectively. Older adults are also at a higher risk of experiencing TBI, as well as any adult taking blood thinners.

Another problem is that there isn’t a single test that can be used to diagnose traumatic brain injury. Doctors primarily rely on physical examinations, CTs, and MRIs, and sometimes with mild injuries, these imaging methods can’t detect abnormalities. CTs, especially, are unable to detect microscopic injuries to nerve fibers. Additionally, individuals with TBI who experience mood swings or behavioral changes may opt for mental health without disclosing that they’ve sustained a head injury, so their symptoms are diagnosed as psychiatric, leading to an inadequate treatment plan.

10. Arterial Thromboembolism

Lastly, arterial thromboembolism refers to clots in the arteries that interrupt blood flow to various organs or body parts, including the legs, feet, brain, heart, kidneys, intestines, and eyes. Depending on where the clots are, a person could experience cold arms or legs, numbness or tingling, blisters, and generalized pain in the body. Other people may not experience any symptoms at all.

Like venous thromboembolism, arterial thromboembolism can be caused after surgery. It can also be caused by smoking, high cholesterol, or any injury to the arteries. Those who live a sedentary lifestyle or are older are at a higher risk of this condition.

Arterial thromboembolism is typically diagnosed using angiograms, which examine the blood vessels, Doppler ultrasounds, and MRIs. If it’s not treated or misdiagnosed, it can lead to permanent damage to the affected organs, shock, stroke, necrosis, infections, amputation, and even death.

What to Do After a Misdiagnosis

The Agency for Healthcare Research and Quality study, along with the other studies highlighted in this article, shows that misdiagnoses are, unfortunately, part of everyday life.

If you think you’ve been misdiagnosed, now is the time to act.

1. After a medical diagnosis, always get a second opinion.
2. If your treatment plan isn’t working, talk to your healthcare provider.
3. Consult a medical malpractice attorney if your condition has significantly worsened or if a family member has been severely impacted or died due to a misdiagnosis. Having an attorney by your side is essential when fighting against the healthcare industry.

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Giroux Pappas Trial Attorneys represents individuals and families throughout Michigan. If you think you’ve been misdiagnosed, our dedicated and experienced team of medical malpractice attorneys can help you understand how to move forward with your malpractice case. We’ve been providing zealous representation to clients in Michigan for over three decades and have taken over 120 cases to trial.

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