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Misdiagnosis of Cervicocephalic Artery Dissection in the Emergency Department
- Source :
- Stroke
- Publication Year :
- 2020
-
Abstract
- Background and Purpose— Cervicocephalic artery dissection is an important cause of stroke. The clinical presentation of dissection can resemble that of benign neurological conditions leading to delayed or missed diagnosis. Methods— We performed a retrospective cohort study using statewide administrative claims data from all Emergency Department visits and admissions at nonfederal hospitals in Florida from 2005 to 2015 and New York from 2006 to 2015. Using validated International Classification of Diseases, Ninth Revision, CM codes , we identified adult patients hospitalized for cervicocephalic artery dissection. We defined probable misdiagnosis of dissection as having an Emergency Department treat-and-release visit for symptoms or signs of dissection, including headache, neck pain, and focal neurological deficits in the 14 days before dissection diagnosis. Multivariable logistic regression was used to compare adverse clinical outcomes in patients with and without probable misdiagnosis. Results— Among 7090 patients diagnosed with a dissection (mean age 52.7 years, 44.9% women), 218 (3.1% [95% CI, 2.7%–3.5%]) had a preceding probable Emergency Department misdiagnosis. After adjustment for demographics and vascular risk factors, there were no differences in rates of stroke (odds ratio, 0.82 [95% CI, 0.62–1.09]) or in-hospital death (odds ratio, 0.26 [95% CI, 0.07–1.08]) between dissection patients with and without a probable misdiagnosis at index hospitalization. Conclusions— We found that ≈1 in 30 dissection patients was probably misdiagnosed in the 2 weeks before their diagnosis.
- Subjects :
- Adult
Male
Pediatrics
medicine.medical_specialty
New York
Dissection (medical)
Logistic regression
Article
medicine
Humans
Diagnostic Errors
Stroke
Aged
Retrospective Studies
Advanced and Specialized Nursing
Neck pain
Rupture, Spontaneous
business.industry
Retrospective cohort study
Emergency department
Odds ratio
Cerebral Arteries
Middle Aged
medicine.disease
Florida
Female
Neurology (clinical)
medicine.symptom
Presentation (obstetrics)
Cardiology and Cardiovascular Medicine
business
Emergency Service, Hospital
Subjects
Details
- ISSN :
- 15244628
- Volume :
- 51
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....1a3109445b46f1bad3fd05bdb66125a0