Cleveland Hospital Study Finds Misdiagnoses

Feb. 15 -- Some of the sickest of the sick can be found in the Cleveland Clinic Foundation's intensive care unit.

Their vital signs are monitored moment-to-moment.

During 1994 and 1995, 400 patients died in the clinic's ICU, and autopsies were performed on 91 of them. In the autopsy process, pathologists remove and analyze virtually every organ in the body.

"What the autopsy allows you is to have a more in-depth study of the different organs of the patient and most of the time, it is a study that will allow you to make a definite diagnosis," says Dr. Alejandro Arroliga of the Cleveland Clinic.

Medical Problems Overlooked

Arroliga and his colleagues compared the autopsy results to the patients' medical records, and they found that 20 percent of the patients had actually been misdiagnosed. While their study does not conclude that the misdiagnoses contributed to any of the deaths, it does conclude that 44 percent of those cases were examples of major misdiagnosis, resulting in incomplete or inadequate treatment.

The study was published today in the CHEST, the journal of American College of Chest Physicians.

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The Cleveland Clinic is an internationally renowned medical center with state-of-the-art diagnostic facilities. Other autopsy studies from other hospitals have found much higher rates of misdiagnosis.

"It happens because health care now is very effective and very complicated," says Lucian Leape of the Harvard School of Public Health, who studies the quality of care patients receive. "They are exposed to dozens and dozens of different kinds of studies, different treatments and interventions and each of these has some potential for error. It's actually very small but when you do a lot of things, they add up."

Among the most commonly overlooked medical problems were infections and blood clots in the lungs.

Autopsies Performed Less Frequently

No one knows the true extent of these misdiagnoses because so few autopsies are now being done. The autopsy rate in the United States has dropped from about 50 percent of deaths in the 1950s to only about 10 percent today.