Transferring diagnosis versus actual diagnosis at a center for thoracic aortic disease.
BACKGROUND
Lack of physician awareness of thoracic aortic disease has received increased media attention. As a referral center for thoracic aortic disease our institutional experience confirms discrepancies between the transferring diagnosis and the actual pathologic diagnosis. A retrospective review was undertaken to identify the incidence and sources for disparate diagnoses.


METHODS
Medical records from 100 consecutive patients transferred to The University of Florida--Shands Hospital between April 2002 and October 2003 were reviewed. To identify sources for error, the charts of 24 patients with diagnostic discrepancies were examined in detail with attention to outside radiologic reports, level of physician experience, and additional diagnostic testing required.


RESULTS
The transferring diagnosis of 24 patients was different from the final aortic pathologic disease. The most common discrepancies were misclassifications of dissections and aneurysms. Seven patients had either no leak or no dissection. Two patients had misleading "pulsation artifacts" on their computed tomographic scans. In half of the patients diagnostic differences were secondary to initial misinterpretation by the referring radiologist. Seventeen of 24 patients underwent additional diagnostic testing. Misdiagnoses were more common when the referring physician was not a surgeon (15 of 24). The diagnosis of 5 patients was confirmed only in the operating room.


CONCLUSIONS
A significant incidence of disparate diagnosis was identified between transferring facilities and our referral center. Discrepancies were secondary to initial radiographic misinterpretation and the complexity of thoracic aortic pathologic disease. Medical schools and continuing medical education programs should place increased emphasis on thoracic aortic disease in their curricula.
Beaver
Thomas M
TM
Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida 32610-0286, USA. beavetm@surgery.ufl.edu
Herrbold
Francis N
FN
Hess
Philip J
PJ
Klodell
Charles T
CT
Martin
Tomas D
TD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology*; D001018:Aortic Diseases / Q000175:diagnosis*; D002648:Child; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed