Diagnostic errors may be one overlooked factor in the battle to drive down the unnecessary use of antibiotics, according to a study released Monday by the Minneapolis VA Medical Center. An analysis found that in nearly every case where a patient's initial diagnosis was undetermined—listed as a symptom rather than a disease—or was later found to be totally incorrect, the patient was given a course of antibiotics they didn't need.
Despite concerted national efforts over the past few years to rein in the over-prescribing of antibiotics, “There is still a huge amount of room for improvement,” said lead study author Dr. Gregory Filice, an infectious disease specialist with the Minneapolis VA Health Care System. “And if you look at overall hospital antibiotic use, diagnostic errors are likely a big part of it,” he said.
Filice and a team of researchers evaluated 500 randomly selected VA inpatients who received antibiotics between October 2007 and September 2008. Four physicians who were board-certified in internal medicine and infectious diseases judged the accuracy of the initial diagnoses.
Reviewers came to different diagnostic conclusions in more than a third of the cases, the review found. And when there was disagreement, patients were more likely to be prescribed unnecessary antimicrobial drugs.