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Abstract Details

Patient Harm From Diagnostic Error of Neuro-Ophthalmologic Conditions
Neuro-ophthalmology/Neuro-otology
Neuro-ophthalmology/Neuro-otology Posters (7:00 AM-5:00 PM)
005
To prospectively examine diagnostic error of neuro-ophthalmic conditions and resultant patient harm.

Neuro-ophthalmic conditions are frequently misdiagnosed.
Prospective study of 496 consecutive adult new patients seen in consultation at three university-based tertiary neuro-ophthalmology centers in the United States. Collected data included demographics, prior care, referral diagnosis, final diagnosis, diagnostic testing, treatment, patient disposition, and impact of the neuro-ophthalmologic encounter. The causes of error were identified using the Diagnosis Error Evaluation and Research (DEER) taxonomy tool, and patient harm from misdiagnoses was assessed.

242 (49%) patients were misdiagnosed (incorrect or absent referral diagnosis). 62/242 (26%) misdiagnosed patients suffered harm, and in 60/62 (97%), the harm could have been prevented by earlier referral to neuro-ophthalmology. 116/496 (23%) experienced inappropriate laboratory testing, diagnostic imaging, or treatment prior to referral, with higher rates for patients misdiagnosed prior to referral (34%) vs those with a correct diagnosis (13%) (p<0.0001).

The most common reasons for referral were optic neuropathy (102/496, 21%), papilledema (94/496, 19%), diplopia or cranial nerve palsies (79/496, 16%), and unspecified vision loss (55/496, 11%). 434/496 (88%) were appropriate referrals. 47/62 (76%) inappropriate referrals were misdiagnosed vs 195/434 (45%) appropriate referrals (p<0.0001). The most common sources of diagnostic error were the physical examination (36%) (inaccurate funduscopic or motility examinations, underweighing normal examination findings); generation of a differential diagnosis (24%); history taking (24%); and utilization or interpretation of diagnostic testing (13%) (failure to obtain appropriate neuroimaging, poor interpretation of or failure to obtain visual fields).

In 489/496 (99%) patients, neuro-ophthalmologic consultation impacted patient care. Misdiagnosis and inappropriate referrals correlated with increased impact (p<0.0001). Avoiding harmful treatment and providing urgent referral were more common in patients misdiagnosed (17%) vs those correctly diagnosed (4%).
Misdiagnosis of neuro-ophthalmic conditions, mismanagement prior to referral, and preventable harm are common. Early appropriate referral to neuro-ophthalmology should prevent patient harm.
Authors/Disclosures
Leanne Stunkel, MD (Washington University in St. Louis)
PRESENTER 		Dr. Stunkel has nothing to disclose.
No disclosure on file
Devin D. Mackay, MD, FÂ鶹´«Ã½Ó³»­ (Indiana University) Dr. Mackay has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Optum. Dr. Mackay has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for various law firms.
No disclosure on file
Gregory P. Van Stavern, MD, FÂ鶹´«Ã½Ó³»­ (Washington University Ophthalmology) Dr. Van Stavern has received publishing royalties from a publication relating to health care.
Nancy J. Newman, MD, FÂ鶹´«Ã½Ó³»­ (Emory University School of Medicine) Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Phelcom. The institution of Dr. Newman has received research support from GenSight. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.
Valerie Biousse, MD Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Topcon. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.