Wrong, wrong, wrong, you don't need more training of ER doctors, you need to come up with a fast, easy and objective test that doesn't need a doctor at all.
When are we going to fund researchers to test out these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder?
http://www.news-medical.net/news/20150724/Extremes-of-stroke-symptoms-attract-misdiagnoses.aspx
Patients with very mild or very severe stroke symptoms are at the
greatest risk of being misdiagnosed in the emergency department,
research suggests.
These “stroke chameleons” were mostly missed by
emergency physicians, who failed to consider a stroke diagnosis in
91.5% of the 47 patients studied. However, neurologists also did not
consider stroke in 57.6% of the 33 patients about whom they were
consulted.
“Based on our data, some stroke chameleons may be
preventable in part by educating physicians about unusual presentations
of stroke”, say Benjamin Richoz (Centre Hospitalier Universitaire
Vaudois and University of Lausanne, Switzerland) and co-researchers.
They also suggest lowering the threshold for consulting a neurologist.
Another
problem was coexisting neurological and psychiatric conditions, which
“often masked correct stroke diagnosis”, leading to misattribution of
symptoms in 19.1% of patients.
The stroke chameleon patients were
identified from among 2200 acute ischaemic stroke patients admitted to a
single centre over 8.25 years. Richoz et al stress that, had they been
correctly diagnosed, 23.4% of the stroke chameleon patients would have
been eligible for thrombolysis.
Misdiagnosis had consequences for
patient outcomes. Significantly fewer stroke chameleon patients achieved
a favourable 12-month outcome, at 50.0% versus 61.6% of correctly
diagnosed patients, and they were more likely to die, at 30.4% versus
19.4%, and to have a recurrence, at 13.3% versus 9.9%.
Most
independent predictors of misdiagnosis were indicative of mild stroke in
younger patients with a low-risk profile. Pre-existing use of
lipid-lowering drugs and the presence of eye deviation reduced the risk
by 70% to 80%, and the risk of misdiagnosis also declined with older age
and higher diastolic blood pressure.
The
researchers call the tendency to misdiagnose patients with a low-risk
profile “understandable”, but say “it shows the importance of educating
medical personnel of the possibility of stroke in young patients with
acute, unexplained neurologic symptoms.”
Cerebellar stroke was 3.78-fold more likely to be misdiagnosed than other strokes, in line with previous studies.
Many
stroke chameleon patients had low National Institutes of Health Stroke
Scale scores, but a group had very high scores, of around 25 to 35, and
unexplained decreased level of consciousness was a frequent
misdiagnosis, given to 21.3% of patients. Eleven patients presented in a
stupor or coma, mostly because of basilar artery occlusion.
“This
presentation may mislead physicians to suspect a metabolic, toxic, or
anoxic encephalopathy rather than stroke”, writes the team in Neurology.
Even
brain imaging did not always prevent misdiagnosis; indeed, it
contributed to the wrong diagnosis in 40.4% of the patients. In nine
patients, noncontrast computed tomography (CT) findings were
misinterpreted, with subtle, early ischaemic changes often overlooked,
and 10 patients had no changes, leading to the exclusion of stroke as a
diagnosis.
The team therefore advises “the more systematic use” of
more sensitive imagining techniques such as multimodal CT and magnetic
resonance imaging.
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