A recent study at Baylor College of Medicine found that patients who presented to emergency rooms with acute abdominal pain were more likely to be misdiagnosed than other patients. The major reasons for the incorrect diagnoses were incomplete or incorrect history or exam and failure to order tests to determine the cause of the pain.

Acute abdominal pain is a common presenting symptom in emergency rooms. Because this is a non-specific symptom (i.e., it could represent many different conditions or causes), it is incumbent on the ER physician to take a very careful history and consider what imaging studies or other tests are needed to come up with a differential diagnosis and hopefully rule out potentially dangerous causes.

The Baylor researchers used electronic health records to identify 100 patients who had presented with abdominal pain and who returned within 10 days after their first ER visit and were admitted to the hospital when they returned. They further reviewed data from the electronic records for these patients to find 35 diagnostic errors that were made in the first ER visit. Two-thirds of those errors were then traced back to the history taking or examination or the ordering (or failure to order) further testing or imaging. There were also errors in following up on tests or imaging results. Of the diagnostic errors, two could have caused immediate death, one had the potential for very serious immediate damage, and two more had the potential for serious, long-term harm.

One of the study authors, Dr. Hardeep Singh, noted the importance of the research results in light of the recent Institute of Medicine report that everyone will likely have one serious misdiagnosis in their lifetime. He felt that the study will allow emergency room physicians to “develop strategies that use electronic health records data to identify which people should be selected for further review and study.”