Older adults might present with atypical symptoms, such as “just not feeling right.” Some experience a decreased sensation of dyspnea itself, so they do not even report feeling short of breath. Older patients also may present with various comorbid conditions that are causing shortness of breath, such as congestive heart failure or COPD. This can lead to misdiagnosis.
The ECG in the figure was obtained from a man in his 30s. How would one interpret this tracing if told the patient’s only symptom was recent shortness of breath on exertion that he had not experienced?
Failure to timely diagnose, failure to order diagnostic tests, and failure to interpret diagnostic tests were the most frequent allegations in malpractice claims involving aortic dissection, according to an analysis of claims filed between 1994 and 2019.
Frequent ED visitors account for 10% to 26% of all ED visits, and are responsible for a growing proportion of healthcare expenditures. The risk of ED super-use is more likely for older patients and those in poorer health. The most common diagnoses were low back pain, nausea and vomiting, chest pain, headache and migraine, urinary tract infection, and abdominal pain.
In a large cohort of asymptomatic patients with hemodynamically significant chronic aortic regurgitation, volumetric left ventricular size and function measurements were equally discriminant in identifying patients at higher risk for mortality vs. traditional linear measurements.
Perceived litigation risk has been often cited as one of the top reasons for ordering low-value imaging in many settings, including the ED. Higher costs and more radiation exposure (and hospitalizations) probably could have been avoided in many cases. Yet EPs know it is possible they will be sued for failing to order a diagnostic test.
Strokes, especially posterior circulation events, are associated with significant diagnostic error in the ED. Machine learning models can be designed to capture subtle signs and assist providers in catching cases that might otherwise go undetected.