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X-ray review confirms nine missed cancers
[Posted: Tue 04/11/2008 by Niall Hunter, Editor www.irishhealth.com]
Nine missed cancer diagnoses have been confirmed in the long-awaited report on the review of thousands of chest x-rays and 70 CT scans carried out at two north-east hospitals.
Eight of the patients concerned have since died.
The HSE today apologised to the families of the patients who were harmed by the delayed lung cancer diagnoses. The review report centred on the work of a locum consultant radiologist employed at Drogheda and Navan Hospitals between August 2006 and August 2007.
The report states that in one of the missed cancer cases, a very substantial chance of cure was denied while in five other cases a small chance of cure was denied. In only two of the missed diagnosis patients was there no chance of cure at the time of the original x-ray mis-report.
The report also points out that in eight patients who were misdiagnosed, the period of uncertainty in diagnosis led to a delay in them getting timely palliative care, resulting in prolonged distress, pain or discomfort.
The report says in addition to the cancer misdiagnoses, a number of 'significant errors' in reporting that were sent for clinical chart review were judged not to have caused any clinical harm.
However, the report stresses that harm was only averted as a result of the alertness of other clinicians, other clinical information or tests or other factors.
The report identifies hundreds of 'unreported findings' on the locum consultant's original x-rays that were, however, deemed unlikely to have any clinical significance.
The consultant, who is from Scotland, has been referred to the Medical Council in Ireland and the General Medical Council in the UK for investigation.
The main finding of the review is that nine patients had their diagnosis of cancer delayed by some months as a result of missed radiological diagnoses.
According to the HSE, all of these patients whose diagnosis was delayed had their cancer diagnosed before the look-back began, and the review did not find any additional undiagnosed cases of lung cancer.
The HSE says the review acknowledges that the delayed diagnoses had varying impacts on the care and treatment of the patients concerned.
"These included lost opportunities in relation to cure prospects, additional lifespan and earlier palliative care."
The misdiagnosis led to worry, uncertainty and distress for families and reduced the time available to them to come to terms with the serious diagnosis and the impending death of their family member, the HSE said.
The report says in the cases where a small chance of cure had been denied by delayed diagnosis, the families would have the added burden of trying to deal with that very difficult issue.
"This included the tragic impact on a family whose relative lost a major chance of cure for her cancer."
In addition to the nine missed diagnoses, the review found two cases of 'tiny probably lung tumours' in patients scanned for other reasons arising from the review.
The HSE says these tumours were found when the patients were re-tested but were not present or visible 'even in retrospect' on the previous examinations.
The report says these represent new tumours arising between the initial and subsequent x-ray tests.
The investigation initially examined 5,835 chest x-rays and 67 CT scans. The total number of patients whose examinations were reviewed was 4,936, of which 4,289 did not require further action.
However, 618 patients were re-assessed by clinical experts following the initial review, which found either an unreported finding likely to be insignificant but one that should be recorded, or a significant error.
Of this group, it was found 339 required no further action.
Two hundred and seventy patients in this group had an unreported finding unlikely to have any clinical significance, but one that needed to be recorded, such as evidence of an old healed TB, according to the report, and supplementary reports were drawn up for the referring physician or GPs of these patients.
Finally, nine patients had a confirmed delayed diagnosis of lung cancer, after the tumour was not picked up on the initial test by the locum radiologist. This figure included the three confirmed cases that prompted the review.
All of these nine patients had been identified and diagnosed prior to March 2008. The review did not therefore find any previously undiagnosed lung cancers.
The review of CT scans found no misdiagnoses.
It was found that 29 patient's x-rays in the review went missing.
In all, the review recalled 92 patients for additional x-rays or CT scans.
One patient who was reviewed initially declined further diagnostic tests.
This patient was found to have had an unreported finding unlikely to have any clinical significance, but one that should be recorded. The family of this patient have requested a full review of the case.
The review found that the quality of imaging at the hospitals was generally excellent.
The HSE says in response to matters raised in the report, its north-east hospital network is adding to its existing patient safety measures by beginning an additional project to enhance clinical governance in the radiology service in the hospital group.
The HSE has been criticised for the length of time it took to organise the review as it was first known that misdiagnoses had been reported in the autumn of 2007. The review began in May of this year.
See also 'The human cost of cancer errors'...http://www.irishhealth.com/index.html?level=4&id=14568
|hammer Posted: 04/11/2008 16:21|
|Why is it always blamed on a locum ? Who is responsible for monitoring their work. Is it just automatically taken that they are competent based on some sort of interview ?|
|brandy Posted: 04/11/2008 17:37|
|hammer, Funny you mention that....think it was last year I heard on the radio that (at the time) there was some doubt re the qualifications of the locums; that they weren't properly vetted etc! With the history now coming out....would we trust the HSE to have ironed that problem out?? errr....DON'T THINK SO!!!|
|CATHY Posted: 06/11/2008 21:42|
|25 Radiologists review one Radiologist's work!! and with Hindsight bias as quoted in the review, Yes ladies and gentleman any hospital around the country and world will have the same stats!!! Read the following from the Review: Chest radiographs or x-rays are performed as overview survey examinations for patients presenting with numerous conditions such as chest infections, bronchitis, asthma, accidents, injuries, chest pain, and heart failure. Published studies on variation or error rates in interpreting chest radiographs, particularly in respect of detecting lung tumours, show remarkable variability. This reflects the well-recognised complexity of chest x-ray reporting, where a multiplicity of normal and non-specific shadows compete for the radiologist’s attention and challenge his interpretive judgement. In reviews of this kind, which involve a re-examination of radiological examinations, a phenomenon known as hindsight bias is internationally accepted as impacting to some degree on the results. While methodologies for reviews are carefully designed to reproduce the original reporting circumstances, the fact that reviewers are aware of the review process creates an unavoidable higher level of sensitivity. This increases the likelihood of spotting results that may reasonably have not been previously observed or reported. An extension of this is known as outcome bias, where when one knows that a condition has later been diagnosed, it becomes ‘easier’ to appreciate on review of an examination.|
|CATHY Posted: 06/11/2008 21:44|
|Funny that the review does not include the referring clinicians notes or follow up. They are ultimately responsible for the patients.|
|CATHY Posted: 06/11/2008 21:44|
|Even more funny, we only read certain parts of the review and jump to conclusions.|
|Judy Posted: 07/11/2008 08:24|
|It seesm like these tradgedies never end. This is beyond deplorable. I agree with you hammer, there has to be some sort of checking system for the locums' work but given how ALL medical staff seem to be so over-stretched it doesn't look like this happened.|
|CATHY Posted: 07/11/2008 12:43|
|Locums are qualified docs as well, 90% of the services around the country use them and now they are abusing them. Again, it all comes to the simple fact the clinicians do not care nor follow up their patients nor discuss with the radiologists. But they are so eager to shift the blame. Some locums are better than the permanent docs!!!|
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