Early access to a neurologist reduces the rate of missed diagnosis in young strokes

Wazim Mohamed, Pratik Bhattacharya, Seemant Chaturvedi

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: We hypothesized that the presence of an in-house neurologist or a neurology or emergency medicine (EM) residency is associated with a lower rate of missed stroke diagnosis and a greater use of thrombolytic therapy. Methods: The outpatient Young Stroke registry from our academic medical center was reviewed. Patients 16 to 50 years of age who presented with ischemic stroke were included. Information on presentation, acute therapy, and missed diagnosis was obtained. The presence of an EM or neurology residency at the presenting hospital was recorded. We also assessed whether hospital teaching status in these fields affected missed diagnosis rates, the use of thrombolysis, or stroke intervention. Results: Ninety-three patients were included. Thirteen patients were misdiagnosed. In hospitals with and without a neurology residency, the missed diagnosis rate was 6.3% versus 18.0%, respectively (P =.21). Two patients were misdiagnosed in hospitals with a neurology residency, but neither had neurology consultations in the emergency department. If these cases are removed from our analysis, the rate of missed diagnosis with and without a neurology residency is 0% versus 20.6%, respectively (P =.008). Acute stroke therapy was administered in 17.9% of patients seen with an EM residency, compared to 2.7% without an EM residency (P =.046). With and without a neurology residency, acute stroke therapy was administered in 25% versus 8.2% of cases, respectively (P =.055). Conclusions: Young adults with ischemic stroke seen at hospitals with a neurology residency had a lower missed diagnosis rate. The presence of an EM resident or a neurology teaching program was associated with a greater use of acute stroke therapies. These results support initiatives to triage young adults with suspected acute stroke to hospitals with access to neurologic expertise in the emergency department.

Original languageEnglish (US)
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number8
DOIs
StatePublished - Nov 2013
Externally publishedYes

Fingerprint

Neurology
Internship and Residency
Stroke
Emergency Medicine
Diagnostic Errors
Hospital Emergency Service
Young Adult
Neurologists
Triage
Thrombolytic Therapy
Therapeutics
Teaching Hospitals
Nervous System
Registries
Teaching
Outpatients
Referral and Consultation

Keywords

  • Missed diagnosis
  • patient safety
  • stroke
  • young adults

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Early access to a neurologist reduces the rate of missed diagnosis in young strokes. / Mohamed, Wazim; Bhattacharya, Pratik; Chaturvedi, Seemant.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 8, 11.2013.

Research output: Contribution to journalArticle

@article{d3052d3c8a6c47acbb10dbfe1e5781f5,
title = "Early access to a neurologist reduces the rate of missed diagnosis in young strokes",
abstract = "Background: We hypothesized that the presence of an in-house neurologist or a neurology or emergency medicine (EM) residency is associated with a lower rate of missed stroke diagnosis and a greater use of thrombolytic therapy. Methods: The outpatient Young Stroke registry from our academic medical center was reviewed. Patients 16 to 50 years of age who presented with ischemic stroke were included. Information on presentation, acute therapy, and missed diagnosis was obtained. The presence of an EM or neurology residency at the presenting hospital was recorded. We also assessed whether hospital teaching status in these fields affected missed diagnosis rates, the use of thrombolysis, or stroke intervention. Results: Ninety-three patients were included. Thirteen patients were misdiagnosed. In hospitals with and without a neurology residency, the missed diagnosis rate was 6.3{\%} versus 18.0{\%}, respectively (P =.21). Two patients were misdiagnosed in hospitals with a neurology residency, but neither had neurology consultations in the emergency department. If these cases are removed from our analysis, the rate of missed diagnosis with and without a neurology residency is 0{\%} versus 20.6{\%}, respectively (P =.008). Acute stroke therapy was administered in 17.9{\%} of patients seen with an EM residency, compared to 2.7{\%} without an EM residency (P =.046). With and without a neurology residency, acute stroke therapy was administered in 25{\%} versus 8.2{\%} of cases, respectively (P =.055). Conclusions: Young adults with ischemic stroke seen at hospitals with a neurology residency had a lower missed diagnosis rate. The presence of an EM resident or a neurology teaching program was associated with a greater use of acute stroke therapies. These results support initiatives to triage young adults with suspected acute stroke to hospitals with access to neurologic expertise in the emergency department.",
keywords = "Missed diagnosis, patient safety, stroke, young adults",
author = "Wazim Mohamed and Pratik Bhattacharya and Seemant Chaturvedi",
year = "2013",
month = "11",
doi = "10.1016/j.jstrokecerebrovasdis.2013.01.013",
language = "English (US)",
volume = "22",
journal = "Journal of Stroke and Cerebrovascular Diseases",
issn = "1052-3057",
publisher = "W.B. Saunders Ltd",
number = "8",

}

TY - JOUR

T1 - Early access to a neurologist reduces the rate of missed diagnosis in young strokes

AU - Mohamed, Wazim

AU - Bhattacharya, Pratik

AU - Chaturvedi, Seemant

PY - 2013/11

Y1 - 2013/11

N2 - Background: We hypothesized that the presence of an in-house neurologist or a neurology or emergency medicine (EM) residency is associated with a lower rate of missed stroke diagnosis and a greater use of thrombolytic therapy. Methods: The outpatient Young Stroke registry from our academic medical center was reviewed. Patients 16 to 50 years of age who presented with ischemic stroke were included. Information on presentation, acute therapy, and missed diagnosis was obtained. The presence of an EM or neurology residency at the presenting hospital was recorded. We also assessed whether hospital teaching status in these fields affected missed diagnosis rates, the use of thrombolysis, or stroke intervention. Results: Ninety-three patients were included. Thirteen patients were misdiagnosed. In hospitals with and without a neurology residency, the missed diagnosis rate was 6.3% versus 18.0%, respectively (P =.21). Two patients were misdiagnosed in hospitals with a neurology residency, but neither had neurology consultations in the emergency department. If these cases are removed from our analysis, the rate of missed diagnosis with and without a neurology residency is 0% versus 20.6%, respectively (P =.008). Acute stroke therapy was administered in 17.9% of patients seen with an EM residency, compared to 2.7% without an EM residency (P =.046). With and without a neurology residency, acute stroke therapy was administered in 25% versus 8.2% of cases, respectively (P =.055). Conclusions: Young adults with ischemic stroke seen at hospitals with a neurology residency had a lower missed diagnosis rate. The presence of an EM resident or a neurology teaching program was associated with a greater use of acute stroke therapies. These results support initiatives to triage young adults with suspected acute stroke to hospitals with access to neurologic expertise in the emergency department.

AB - Background: We hypothesized that the presence of an in-house neurologist or a neurology or emergency medicine (EM) residency is associated with a lower rate of missed stroke diagnosis and a greater use of thrombolytic therapy. Methods: The outpatient Young Stroke registry from our academic medical center was reviewed. Patients 16 to 50 years of age who presented with ischemic stroke were included. Information on presentation, acute therapy, and missed diagnosis was obtained. The presence of an EM or neurology residency at the presenting hospital was recorded. We also assessed whether hospital teaching status in these fields affected missed diagnosis rates, the use of thrombolysis, or stroke intervention. Results: Ninety-three patients were included. Thirteen patients were misdiagnosed. In hospitals with and without a neurology residency, the missed diagnosis rate was 6.3% versus 18.0%, respectively (P =.21). Two patients were misdiagnosed in hospitals with a neurology residency, but neither had neurology consultations in the emergency department. If these cases are removed from our analysis, the rate of missed diagnosis with and without a neurology residency is 0% versus 20.6%, respectively (P =.008). Acute stroke therapy was administered in 17.9% of patients seen with an EM residency, compared to 2.7% without an EM residency (P =.046). With and without a neurology residency, acute stroke therapy was administered in 25% versus 8.2% of cases, respectively (P =.055). Conclusions: Young adults with ischemic stroke seen at hospitals with a neurology residency had a lower missed diagnosis rate. The presence of an EM resident or a neurology teaching program was associated with a greater use of acute stroke therapies. These results support initiatives to triage young adults with suspected acute stroke to hospitals with access to neurologic expertise in the emergency department.

KW - Missed diagnosis

KW - patient safety

KW - stroke

KW - young adults

UR - http://www.scopus.com/inward/record.url?scp=84889032170&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889032170&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2013.01.013

DO - 10.1016/j.jstrokecerebrovasdis.2013.01.013

M3 - Article

C2 - 23422347

AN - SCOPUS:84889032170

VL - 22

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

IS - 8

ER -