Misdiagnosed Strokes Common For Women And Minorities

By Jane Farrell

ER doctors overlook or minimize early signs of stroke in tens of thousands of patients, especially with minorities, women and people under 45 – often in the week before they suffered the debilitating incident.

A report on the research, from a team led by a Johns Hopkins specialist, was published in the journal Diagnosis.

In analyzing federal health care data, the investigators said that 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.

“It’s clear that ER physicians need to be more discerning and vigilant in ruling out stroke, even in younger people,” says study leader David E. Newman-Toker, M.D., Ph.D., an associate professor of neurology at Johns Hopkins. “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.”

Newman-Toker says 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 analyze stroke misdiagnosis. His team linked inpatient discharge records and emergency department visit records from 187,188 patients and 1,016 hospitals. They found that up to 12.7 percent of people later admitted for stroke had been potentially misdiagnosed and erroneously sent home in the 30 days preceding stroke hospitalization.

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.

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.

Early diagnosis and quick treatment of strokes are critical for patients who suffer  a transient ischemic attack (TIA) — a so-called “ministroke” or “pre-stroke” — because these temporary, non-disabling conditions are often a sign of a catastrophic bleed or clot in the brain that can lead to death or permanent disability just days later without appropriate treatment.

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. And he notes that physicians should be able to differentiate between dizziness caused by a stroke and one caused by an inner ear problem using a series of relatively simple bedside tests tracking eye movements.