American Medical Informatics Association, Diagnostic Errors in Medicine National Conference, Phoenix, Arizona

 

May 31 - June 1, 2008. 

Misdiagnosis of Carpal Tunnel Syndrome (CTS): A Systematic Misclassification or Error of Omission

MC Mireles, PhD, MPH, Community Medical Foundation for Patient Safety, Bellaire, TX

JA Miller, PhD, Community Medical Foundation for Patient Safety, Bellaire, TX

WC Paske, PhD, Red Oak Instruments, LLC, Katy, TX

Abstract:

The prevalence of CTS is about 3-7% and much higher in the workforce.  Direct medical cost and loss of productivity due to CTS are more than $40 billion (2).  CTS treatment (open-hand or endoscopic ligament release) accounts for 11% of all surgeries preformed annually.  Of all the CTS release surgeries, about 50% fail,.  This study examined some diagnostic factors attributing to this high failure rate.  Specifically, the study examined and compared the sensitivity and specificity of conventional clinical tests (e.g. EMG, Phalen's, Tinel's Sign, Durkan Compression, Semmes-Weinstein and others) to evaluate and diagnose CTS.  The results of the tests consistently show poor sensitivity and specificity.  While the practice of using multiple tests to diagnosis CTS is believed to increase sensitivity, the resultant outcomes indicate multiple tests can reduce the specificity to 50% or less3.  Most diagnostic errors were false positives, suggesting that indicated surgical treatments were unnecessary.  This error is considered a systematic misclassification based on poor specificity of these clinical tests, as well as an error of omission when physicians have only these tests available for use.  Diagnostic error is an important and common medical error that can significantly harm the patient. 

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