Patient Harm Due to Diagnostic Error of Neuro-Ophthalmologic Conditions

PurposeTo prospectively examine diagnostic error of neuro-ophthalmic conditions and resultant harm at multiple sites.DesignProspective, cross-sectional study.ParticipantsA total 496 consecutive adult new patients seen 3 university-based neuro-ophthalmology clinics in the United States 2019 to 2020.MethodsCollected data regarding demographics, prior care, referral diagnosis, final testing, treatment, patient disposition, impact neuro-ophthalmologic encounter. For misdiagnosed patients, we identified cause using Diagnosis Error Evaluation Research (DEER) taxonomy tool whether experienced due misdiagnosis.Main Outcome MeasuresThe primary outcome was who were before as a result misdiagnosis. Secondary outcomes included appropriateness referrals, misdiagnosis rate, interventions undergone referral, type error.ResultsReferral diagnosis incorrect 49% cases. A 26% harm, which could have been prevented by earlier 97%. Patients inappropriate laboratory imaging, or treatment 23%, with higher rates for (34% vs. 13% correct P < 0.0001). Seventy-six percent referrals misdiagnosed, compared 45% appropriate (P The most common reasons optic neuritis neuropathy (21%), papilledema (18%), diplopia cranial nerve palsies (16%), unspecified vision loss (11%). sources physical examination (36%), generation complete differential (24%), history taking use interpretation testing (13%). In 489 (99%), consultation (NOC) affected care. 2% cases, directly saved patient’s life vision; an additional 10%, harmful avoided urgent provided; 48%, provided direction care.ConclusionsMisdiagnosis conditions, mismanagement preventable are common. Early may prevent harm. To sites. Prospective, study. 2020. Collected error. Referral Misdiagnosis