Potential ED Diagnostic Errors Mapped Across Medicare Admissions

Investigators developed a list of 76 emergency diagnosis–sensitive conditions (EDSCs) for measuring diagnostic error in the emergency department (ED), according to a retrospective cross-sectional study of fee-for-service Medicare beneficiaries 65 years or older published in JAMA Network Open.

According to the authors, diagnostic accuracy drives ED quality, but consensus is lacking on which conditions to target. A panel of 5 clinician investigators reviewed principal discharge ICD-10 codes to identify diseases that are emergency care sensitive, at risk of diagnostic error, and should be diagnosed in the ED or on admission.

Of 14,671,540 nonelective admissions from 2022 through 2024, 2,852,901 (19.4%) were for EDSCs. Potential diagnostic errors were defined as ED discharges for a different diagnosis within 9 days before admission, with rates adjusted for background ED use in a comparison cohort. Guillain-Barré syndrome had the highest adjusted percentage of admissions preceded by a potential diagnostic error (16.6%), and acute appendicitis had the lowest (1.4%).

Pneumonia, the most frequent EDSC admission category, had the highest adjusted incidence of potential diagnostic errors (9.30 per 10,000 ED discharges), despite a moderate adjusted error percentage of 4.4%. Ischemic stroke (7.08) and myocardial infarction (3.62) followed. Sixteen EDSCs were designated high priority based on high diagnostic error rates combined with condition-specific morbidity and mortality. Symptom-based diagnoses were common before EDSC admissions; headache was the most frequent prior ED diagnosis category for meningitis or encephalitis.

The authors noted that claims data can flag potential diagnostic errors but generally cannot confirm them or establish preventability. The study excluded Medicare Advantage beneficiaries, and favoring sensitivity over specificity for marginal codes may have overestimated potential diagnostic error for some diseases. The investigators concluded that EDSCs could serve as a framework for estimating the population burden of ED diagnostic error and for future research, quality improvement, and policy interventions.

Source: Burke LG, Burke RC, Orav EJ, et al. Classification of emergency diagnosis-sensitive conditions among Medicare beneficiaries. JAMA Netw Open. 2026;9;(10):e2637682. doi:10.1001/jamanetworkopen.2026.37682