Thousands of patients with early signs of potentially disabling strokes, such as dizziness and headaches, are dismissed by doctors each year, according to new research by Johns Hopkins University.
Women, minorities and young people under 45 years were seen to be significantly more likely to be misdiagnosed in the week before experiencing a debilitating stroke.
Findings were taken from a review of medical records and reported in the journal Diagnosis. Younger people were found to be seven times more likely to be given an incorrect diagnosis and sent home without treatment after visiting ER complaining of dizziness or headache, according to the research.
Lead researcher, David E.Newman-Toker, associate professor of neurology, said: “It’s clear that ER physicians need to be more discerning and vigilant in ruling out stroke, even in younger people. Although stroke is less common in this demographic, we need to be more attuned to the possibility, particularly when the presenting complaint is dizziness or headache.”
Using Healthcare Cost and Utilization Project data from nine states during 2008 and 2009, the study is the first large-scale study to quantify stroke misdiagnosis. Inpatient discharge records were linked with emergency department visit records from 187,188 patients and 1,016 hospitals.
Records showed that 12.7% of people were later admitted for stroke who had been potentially misdiagnosed and sent home in error from ER in the 20 days before being hospitalized by a stroke.
Those misdiagnosed disproportionately presented with symptoms of dizziness or headaches and were told either that:
- they had a benign condition, such as inner ear infection or migraine
- 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.
Data suggested evidence of gender and racial disparities – women were 30% more likely to be misdiagnosed and minorities between 20%-30%.
Researchers believe that the number of missed strokes resulting in harm is likely to be between 50,000 and 100,000 a year.
According to David Newman-Toker, early diagnosis and quick treatment of strokes are critical to the long-term health of patients having a transient ischemic attack (TIA). The TIA is a “ministroke” or “pre-stroke” and these temporary, non-disabling conditions are often a warning signal of an impending catastrophic bleed or clot in the brain. TIAs can lead to death or permanent disability just days later if appropriate treatment is not received.
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 says.
The most common type of stroke is best confirmed using MRI, rather than a CT scan, which often doesn’t show brain changes early on and can be falsely reassuring.
To eliminate misdiagnosis, research lead David Newman-Toker suggests that physicians need to be alert to the dizziness caused by stroke and the dizziness caused by an inner ear problem. This can be identified by a series of simple bedside tests that track eye movements.
In addition to the tests, a thorough medical history should be taken from the patient, especially in regards to their past experiences of headaches. This combined method can reliably rule out a bleeding stroke from brain aneurysm.
The consequences of not considering a stoke and misdiagnosing the early symptoms of headache and dizziness, as this research has shown, can be fatal.
“Most of these misdiagnosed patients, especially the younger ones, are probably people for whom stroke wasn’t really given much consideration or diagnostic assessment,” he says. “And this can have dire consequences.”
Image with thanks to Sanja Gjenero of RGB Stock
Press release: Johns Hopkins University