Clinical Pathology Selected Abstracts, 9/16

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Medical error: a leading cause of death in the United States

The Centers for Disease Control and Prevention compiles an annual list of the most common causes of death in the United States, using death certificates. This process relies on assigning an International Classification of Disease (ICD) code to the cause of death. Consequently, deaths due to human and system factors are not captured. There is growing evidence that communication breakdowns, diagnostic errors, poor judgment, and inadequate skill lead to patient harm and death. The authors analyzed the literature on medical error to identify its contribution to U.S. deaths in relation to the CDC list of common causes of death. They performed a literature review of the studies reporting medical error rates since the 1999 Institute of Medicine (IOM) report. The IOM report described an estimated incidence of 44,000 to 98,000 deaths annually, but in a later study claimed that incidence rate was low. The authors of the study reported herein estimated deaths due to medical error at 251,454 a year using studies released since the IOM report and extrapolating to the total number of hospital admissions in 2013. Comparing this figure to the CDC rankings suggests that medical error is the third most common cause of death in the United States. The authors concluded that to achieve more reliable health care systems and prevent harm, the science of improving patient safety should be based on sharing and comparing data. A step in this direction would be to develop more ICD-10 codes to capture the role of medical error when it is involved in patient death. This would help standardize data collection and reporting and heighten awareness of the need for funding for research and the prevention of medical errors.

Makary MA, Daniel M. Medical error—the third leading cause of death in the US. BMJ. 2016;353. doi:10.1136/bmj.i2139.

Correspondence: M. A. Makary at mmakary1@jhmi.edu

Blood lipid concentrations and colorectal adenomas: review of colonoscopy studies

Dyslipidemia is a proposed risk factor for developing colorectal neoplasia. The incidence of both is growing in Asia, which is prompting investigators to more closely study their relationship. Past studies primarily were conducted in Europe and the United States. The most likely reasons for the increase in colorectal cancer and dyslipidemia in Asia are diet and lifestyle changes. The authors of this study performed a systematic meta-analysis of colonoscopy-based case control studies in Asia between 2000 and 2014. They identified 17 studies that met inclusion criteria, which produced a collective total of 17,387 cases and 30,427 controls. Compared with controls (those that were adenoma-free after colonoscopy), cases had higher total cholesterol, higher low-density lipoprotein cholesterol, higher triglyceride, and lower high-density lipoprotein cholesterol concentrations. Based on adjusted odds ratios, the higher triglyceride and HDL cholesterol levels achieved statistical significance. The authors concluded that people with adenoma were more likely than those without adenoma to have an unfavorable cholesterol profile at the time of colonoscopy. The study showed that hypertriglyceridemia had the strongest association with dyslipidemia and colorectal neoplasia. This finding suggests that prevalent dyslipidemia may be a risk factor for colorectal neoplasia and should be considered when establishing guidelines for colorectal cancer screening and surveillance.

Passarelli MN, Newcomb PA. Blood lipid concentrations and colorectal adenomas: a systematic review and meta-analysis of colonoscopy studies in Asia, 2000–2014. Am J Epidemiol. 2016:183(8):691–700.

Correspondence: Dr. Michael Passarelli at michael.passarelli@ucsf.edu