Cases studied by PRIDE:

37-year-old male with family history of colon cancer seeks care after weeks of poor appetite and jaundice. CT scan showed large mass suggesting sigmoid colon cancer and finally a colonoscopy found a fungating, ulcerated, partially obstructing mass. The diagnostic delay was linked in part to lack of insurance and primary care relationship. Patient underwent treatment but ultimately died at age 41.

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16-year-old male went to the ED and two urgent care visits within a week for lower abdominal pain, vomiting and testicular discomfort. At the second urgent care visit, provider ordered stat urology consult and testicular ultrasound. The ultrasound findings were consistent with right testicular torsion and patient underwent a right orchiectomy.

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71-year-old female in urgent care clinic with one year history of fatigue, anorexia, and weight loss; clinician made no definitive diagnosis. Patient experienced worsening symptoms and was seen by several specialists over the next three months. Ultimately, a definitive diagnosis of myasthenia gravis resulted in urgent therapy.

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16-year-old male seen in emergency center after waking to lower abdominal pain radiating to testicles. CT suggested inflammation of lymph nodes but no ultrasound was ordered. Patient was discharged with advice to return if symptoms recurred. Nine days later he presented with continuing pain where a urologist diagnosed torsion and performed left orchiectomy and right scrotal orchiopexy.

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19-year-old male sought urgent care with right testicular pain. Clinician ruled out testicular torsion based on the patient’s apparent level of pain and gradual onset. Ultrasound was not available at the clinic. Despite no recent sexual activity discharged with epididymitis diagnosis. Patient presented to the emergency department a few days later with persistent right testicular pain. He was sent to the operating room immediately for right orchiectomy due to testicular torsion.

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Cases studied by PRIDE published on AHRQ’s PSNet WebM&M:

An elderly man had iron deficiency anemia with progressively falling hemoglobin levels for nearly 2 years. Although during that time he underwent an upper endoscopy, capsule endoscopy, and repeat upper endoscopy and received multiple infusions of iron and blood, his primary physician maintained that he didn't need a repeat colonoscopy despite his anemia because his previous colonoscopy was negative. The patient ultimately presented to the emergency department with a bowel obstruction, was diagnosed with colon cancer, and underwent surgery to resect the mass.

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Elderly iron deficient man had progressively falling hemoglobin levels for nearly 2 years. During that time he underwent multiple endoscopies and iron and blood infusions. Primary physician maintained that he didn't need a repeat colonoscopy. Patient ultimately presented to the emergency department with bowel obstruction, was diagnosed with colon cancer, and underwent surgery to resect the mass.

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15-year-old girl developed disabling menstrual cramps and heavy bleeding at onset of first menstrual period. Over the next 12 years she sought care from multiple clinicians and received a variety of misdiagnoses. Emergency appendectomy found that endometriosis lesions close to the appendix caused infection; later diagnostic laparoscopy confirmed endometriosis.

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Elderly man with history of urinary difficulties was referred to urology but was reluctant to seek care. A physician assistant ordered several tests and urged patient to self-catheterize. Patient elected not to follow up. Ten weeks later, he sought care with his PCP where his blood pressure and creatinine levels were found to be markedly elevated, 2L of urine were drained via catheter, and he was admitted to the hospital for renal failure.

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Young woman with history of spine surgery in emergency department with progressive low back pain. MRI scan showed lumbar degenerative joint disease and small disc herniation. Patient referred to PT and prescribed medication. Ten days later, she presented to community hospital with fever, inability to walk, and numbness from waist down. Lab tests showed she was in acute renal and liver failure. She was transferred to neurosurgery where a thoracic MRI revealed epidural abscess.

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