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Dismissing Dizziness and Headaches in ER May Put Patients at Risk of Stroke, Misdiagnosis

Recent research indicates that doctors may overlook or discount the early signs of potentially disabling strokes in a great number of Americans each year, many of which are visitors to emergency rooms complaining of dizziness or headaches. The study results suggest that women, minorities, and individuals under the age of 45 who exhibit symptoms of stroke were significantly more likely to be misdiagnosed in the week prior to sustaining a disabling stroke. The study also suggests that younger individuals in the study were nearly seven times more likely to be given an incorrect diagnosis and sent home without treatment despite treatments.

David E. Newman-Toker, MD, PhD, associate professor of neurology at the Johns Hopkins University School of Medicine, led the study. Newman-Toker emphasizes that ER physicians must 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,” Newman-Toker says.

A news release from Johns Hopkins Medicine reports that Newman-Toker’s research used Healthcare Cost and Utilization Project data from nine states for the years 2008 to 2009. His team reportedly linked inpatient discharge records and emergency department visit records from 187,188 patients and 1,016 hospitals.

The team observed that up to 12.7% of individuals later admitted for stroke had been potentially misdiagnosed and erroneously sent home from an ER in the 30 days preceding stroke hospitalization. The team adds that individuals misdiagnosed disproportionately presented with dizziness or headaches and were told they had a benign condition, such as inner ear infection or migraine, or were given no diagnosis at all. The results indicate about half of the unexpected returns for stroke occurred within 7 days, and more than half of these occurred in the first 48 hours.

The researchers say women were 33% more likely to be misdiagnosed and minorities were 20% to 30% more likely to be misdiagnosed, indicating that gender and racial disparities may play a role, the release states.  According to the new data, the estimated number of missed strokes resulting in harm to patients nationwide may range from 15,000 and 165,000 annually. Newman-Toker notes in the release that he believes that number may be between 50,000 and 100,000 a year.

Newman-Toker goes on to emphasize the importance of early diagnosis and quick treatment of strokes in the long-term health of patients sustaining a transient ischemic attack (TIA), as the TIAs often signal a catastrophic bleed or clot in the brain that may lead to death or permanent disability days later without appropriate treatment. Prompt and early treatment may lower the risk of a repeat stroke by as much as 80%, Newman-Toker adds.

Physicians should be able to differentiate between dizziness caused by a stroke and one caused by an inner ear problem using a series of bedside tests tracking eye movements. Recording a good history and asking patients about their experience with headaches can also help reliably rule out a bleeding stroke from brain aneurysm, says Newman-Toker.

In most of these misdiagnosed patients, particularly those who are young, Newman-Toker warns, lack of consideration and assessment for stroke, “can have dire consequences.”

Source: Johns Hopkins Medicine