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    Emergency doctors missing stroke in young women



    Stroke symptoms are frequently missed in women, minorities, and young patients who visit an emergency department (ED), according to a recent study in Diagnosis.

    Researchers at Johns Hopkins University School of Medicine did a cross-sectional analysis using 2008 to 2008 state ED databases from 9 states and the ED visit records from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases. Adult patients who had been admitted for stroke with a treat-and-release ED visit in the past 30 days were identified. Patients given a non-cerebrovascular (benign headache or dizziness) or any other diagnosis were considered as probable or potential missed strokes, respectively.

    In the population, there were 23,809 potential (12.7%) and 2243 probable (1.2%) missed stroke admissions. Headache complaints were linked with missed hemorrhages (n= 406) whereas headache or dizziness had a link to missed ischemic strokes (n = 1435) and transient ischemic attacks (n = 402). Men (odds ratio [OR] 0.75), older people (18–44 years [base]; 45–64:OR 0.43; 65–74:OR 0.28; ≥75:OR 0.19), and those on either Medicaid (0.70) or Medicare (OR 0.66) had lower odds of a probable misdiagnosis. However, blacks (OR 1.18), Asian/Pacific Islanders (OR 1.29), Hispanics (OR 1.30), patients at non-teaching hospitals (OR 1.45), and patients at low-volume hospitals (OR 1.57) all had higher odds of probable diagnosis.

    The study authors that estimate 15,000 to 165,000 misdiagnosed cerebrovascular events occur each year in US EDs, many in patients who present with headache or dizziness. They urged doctors to be particularly aware of the potential to misdiagnose when working with younger, female, and non-white patients.



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    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.


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