Article on missed diagnosis of stroke in young people in the ER

Thomas Westover twest54973 at YAHOO.COM
Tue Apr 8 18:25:51 UTC 2014


I agree; retrospectively obtained data after the fact does NOT help prospective decision making!
 
 maybe the research question should have been something like "do pts with stroke have continued neuro sx prior to definitive CVA after a benign ER evaluation?" you would need a comparison cohort obviously to distinguish the prospective characteristics of the cva cohort vs the nonCVA cohort
 
Tom Westover MD
Cooper University Hosp, NJ 
On Tuesday, April 8, 2014 11:35 AM, "Mittal, Manoj K" <MITTAL at EMAIL.CHOP.EDU> wrote:
  
 
Hello, 
The definition for missed diagnosis of stroke used in this study is “We identified adult patients admitted for stroke with a treat-and-release ED visit in the prior 30 days, considering those given a non-cerebrovascular diagnosis as probable (benign headache or dizziness diagnosis) or potential (any other diagnosis) missed strokes.” 
Can somebody help me understand how a patient who presents with headache and a completely normal neurologic exam today and presents/ is diagnosed with a stroke 3 weeks later, be considered a missed diagnosis of stroke the first time? Isn’t this over-reach / Monday morning quarter backing? 
Manoj Mittal, MD 
CHOP 
  
From:lorri Zipperer [mailto:zipperer_info at YAHOO.COM] 
Sent: Tuesday, April 08, 2014 11:30 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Article on missed diagnosis of stroke in young people in the ER   
  
Are mental models about who has a stroke getting in the way of effective diagnosis? This new article could help us understand the potential of that situation existing in emergency roomsand its negative impact on patient safety.  
   
Newman-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.  Diagnosis. 2014 Apr 5; [Epub ahead of print].  
http://www.degruyter.com/view/j/dx.ahead-of-print/dx-2013-0038/dx-2013-0038.xml?format=INT [Free full text].  
http://www.npr.org/blogs/health/2014/04/05/299200133/emergency-docs-more-likely-to-miss-signs-of-stroke-in-the-young  
   
Enjoy!  
   
Lorri Zipperer, Cybrarian  
List Moderator  
Communications Co-Chair  
Society to Improve Diagnosis in Medicine  
http://www.improvediagnosis.org/  
http://www.linkedin.com/groups/Diagnostic-Error-in-Medicine-3986241  
twitter: @ImproveDX  
lorri at zpm1.com  
   
    
  

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