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

Hoffer, Edward P.,M.D. EHOFFER at MGH.HARVARD.EDU
Wed Apr 9 12:16:42 UTC 2014


Like many observational studies, this one is really only hypothesis-generating.  They used back pain and abdominal pain as the "controls" and found these were under-represented as prior ED visits while dizziness and HA were over-represented. So... intriguing but hardly conclusive.
Edward Hoffer MD

From: Mittal, Manoj K [mailto:MITTAL at EMAIL.CHOP.EDU]
Sent: Tuesday, April 08, 2014 12:32 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Article on missed diagnosis of stroke in young people in the ER

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<mailto: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 rooms and 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<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
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lorri at zpm1.com<mailto:lorri at zpm1.com>



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