Early signs and symptoms of stroke are often missed by emergency department doctors, a new study finds.
Every year, tens of thousands of Americans with symptoms such as dizziness or headache are misdiagnosed in the ER in the days or weeks before they suffer a stroke, according to the researchers.
Women, minorities and those under age 45 are the most likely to be misdiagnosed, according to the study published online in the journal Diagnosis.
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"It's clear that ER physicians need to be more discerning and vigilant in ruling out stroke, even in younger people," study leader Dr David Newman-Toker, an associate professor of neurology at the Johns Hopkins University School of Medicine in Baltimore, said in a Hopkins news release.
"Although stroke is less common in [younger people], we need to be more attuned to the possibility, particularly when the presenting complaint is dizziness or headache," Newman-Toker added.
No diagnosis at all
The study authors analysed data from more than 187 000 people who visited more than 1000 US hospitals in nine states during 2008-09. They found that nearly 13% of people later admitted to the hospital with a stroke had been misdiagnosed and sent home from an ER in the 30 days before they were hospitalised.
Many of those misdiagnosed had dizziness and headache and were told they had less serious conditions such as ear infections or migraine, or they received no diagnosis at all, the study found. About half of those misdiagnosed were hospitalised with stroke within seven days, and more than half of those strokes occurred with 48 hours of misdiagnosis.
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The risk of misdiagnosis was 33% higher in women and 20% to 30% higher in minorities, while younger people were nearly seven times more likely to be misdiagnosed, the researchers said.
Based on their findings, the researchers estimated that the number of missed strokes nationwide each year could be between 15 000 and 165 000. Differences in the health data routinely reported by states makes it difficult to estimate more precise numbers, Newman-Toker said in a Hopkins news release.
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