study finds many ers are missing the early signs of stroke

Last week, our blog examined how scientists were continuing to explore whether simple blood tests could be used to help diagnose heart attacks. During this discussion, we reported that statistics have revealed that as many as 2 percent of patients actually suffering heart attacks are misdiagnosed and sent home without further treatment, a scenario that can naturally have deadly consequences.

As if this weren’t scary enough, studies have shown that the rate of diagnostic errors relating to strokes is actually far worse. Indeed, one study found that preventable stroke-related fatalities can be attributed to diagnostic errors over 30 times more often than preventable heart attack-related fatalities.

Similarly, another recent study by researchers at Johns Hopkins University has revealed that many strokes are going misdiagnosed in emergency departments in the days prior to the onset of more obvious symptoms.

As part of the study, published in the latest online edition of the journal Diagnosis, the researchers gathered 2009 emergency department records and inpatient discharge data from federally run databases, as well as 2008-09 emergency department records and inpatient discharge data from nine state-run databases.

After examining data on the 187,188 admissions for stroke, the researchers identified 23,809 instances of potentially missed strokes among patients who had visited the ER within the 30 days prior to their strokes. Among these 23,809 potentially missed strokes, researchers identified 2,243 probable missed strokes among patients who had visited the ER within the 30 days prior to their strokes. Here, these patients complained of perhaps red-flag symptoms such as headaches or dizziness.

Applying these figures to national statistics, which show that there are roughly 1.3 million new or recurring strokes in the U.S. every year, the researchers determined that as many as 15,000 to 165,000 strokes could be misdiagnosed in their early stages in emergency departments across the U.S. every year.

The study found that this early stroke misdiagnosis was particularly acute among minority groups, women and all people younger than 45. It also found that non-teaching hospitals and low-patient-volume hospitals were more likely to see early stroke misdiagnoses.

While the researchers conceded that the study presented certain limitations and needed to be expanded, they did argue that it should perhaps serve as a wakeup call to physicians to be on the lookout for more subtle signs of stroke.

“‘Simple,’ indiscriminate use of neuroimaging will not prove an effective strategy to detect stroke in these patients,” reads the study. “Instead, clinicians should leverage well-studied bedside methods to identify dizziness and headache patients at high risk for stroke.”

Here’s hoping that this study serves as a reminder to all harried ER physicians that they must not be premature in disregarding the possibility that a patient is suffering a stroke. That’s because the failure to stop the progression of a stroke can result in everything from brain damage and paralysis to long-term disability and even death.

Source: Medpage Today, “Stroke rounds: Early signs of stroke missed in many cases,” Todd Neale, April 8, 2014

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