Using the medical records of almost 190,000 patients in 1,016 hospitals, researchers from Johns Hopkins Medicine, Baltimore, believe that emergency department physicians misdiagnose the early signs of stroke in 50,000 to 100,000 patients annually, particularly in women, minorities, and people below the age of 45.

The findings from the medical records review, reported online in the journal Diagnosis, show that women, minorities, and people under the age of 45 who present with symptoms of stroke including dizziness and headache were significantly more likely to be misdiagnosed in the week prior to sustaining a debilitating stroke. Younger people in the study were nearly seven times more likely to be given an incorrect diagnosis and sent home without treatment despite such symptoms.

Lead author David Newman-Toker, M.D., said he believes his research, which used Healthcare Cost and Utilization Project data from nine states for the years 2008–2009, is the first large-scale study to quantify stroke misdiagnosis.

His team linked inpatient discharge records and emergency department visit records from patients and hospitals. They found that up to 12.7 percent of people later admitted for stroke had been potentially misdiagnosed and erroneously sent home from an ED in the 30 days preceding stroke hospitalization. Those misdiagnosed disproportionately presented with dizziness or headaches and were told they had a benign condition, such as inner ear infection or migraine, or were given no diagnosis at all. About half of the unexpected returns for stroke occurred within seven days, and more than half of these occurred in the first 48 hours.

Women were 33 percent more likely to be misdiagnosed and minorities were 20 to 30 percent more likely to be misdiagnosed, suggesting gender and racial disparities may play a role.

Nationwide, the estimated number of missed strokes resulting in harm to patients, based on the new data, could be anywhere between 15,000 and 165,000 annually, though Newman-Toker believes the number is likely between 50,000 and 100,000 a year. He noted that more specific numbers are difficult to estimate because of shortcomings in the health data routinely reported by the states.

Newman-Toker said early diagnosis and quick treatment of strokes are critical to the long-term health of patients having a transient ischemic attack, because these temporary, non-disabling conditions are often a harbinger of a catastrophic bleed or clot in the brain that can lead to death or permanent disability just days later without appropriate treatment. Americans suffer an estimated 800,000 strokes a year, and another 200,000 to 500,000 experience a TIA. Prompt and early treatment may lower the risk of a repeat stroke by as much as 80 percent, Newman-Toker said

 

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