Emergency Departments Often Miss Stroke Diagnosis

Emergency departments may miss strokes before they become obvious, especially in women, minority groups, and patients under 45 years old, a new study reported.

To explore the factors that contribute to a missed stroke, researchers from Johns Hopkins University in Baltimore, MD, conducted a retrospective analysis of records from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases and from the 2008-2009 State ED Databases from 9 states.
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Of the total 187,188 stroke admissions, about 1 of every 10 were discharged with a diagnosis of headache or dizziness.

Overall, they identified 23,809 potential and 2243 probable missed strokes, which represented 12.7% and 1.2% of the stroke admission population, respectively.

Odds of a misdiagnosis were lower for men (OR 0.75), the elderly (18–44 years [base]; 45–64:OR 0.43; 65–74:OR 0.28; ≥75:OR 0.19), and those on Medicare or Medicaid (OR 0.66) and (OR 0.70)

Odds were also higher in non-teaching hospitals (OR 1.45) and low-volume hospitals (OR 1.57).

Researchers estimated that there could be as many as 165,000 misdiagnosed cerebrovascular events each year, after extrapolating the data. 

“Physicians evaluating these symptoms should be particularly attuned to the possibility of stroke in younger, female, and non-White patients.”

–Michael Potts

Toker DE, Moy E, Valente E, Coffey R, Hines AL. Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample[published online ahead of print April 2014]. Diagnosis. DOI: 10.1515/dx-2013-0038