Tampa General nurse negligent in stroke case, jury finds, awards patient $70.8M

 Proof you are required to have the classic symptoms; drooping face, one sided inability to move, speech problems, so your medical 'professionals can actually identify it as a stroke!

Tampa General nurse negligent in stroke case, jury finds, awards patient $70.8M

A Florida jury awarded nearly $71 million to a single mother whose stroke was allegedly missed by a free-standing emergency department. Chiaka Stewart said she had the worst headache of her life, and had recently gone back on birth control -- a risk factor for stroke -- but wasn't given a CT scan and eventually discharged, only to have a stroke 2 days later. (Tampa Bay Times)

State hit with $12M judgment after rookie trooper arrests stroke victim

 

 It is YOUR RESPONSIBILITY  to have the proper stroke indicators(drooping smile, inability to lift arm). You can't do the slurred speech or dizziness one either.

 What is your stroke hospital misdiagnosis rate on strokes?

Have they prevented these problems from happening?

Auckland man dies from stroke after being misdiagnosed with a migraine

 

Factors Associated with Stroke Misdiagnosis in the Emergency Department: A Retrospective Case-Control Study

 

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

 

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

 

Younger Stroke Patients Often Misdiagnosed

 

 Among 821 consecutive patients admitted to an acute stroke unit, the initial diagnosis of stroke proved incorrect in 108 (13%)

 

The latest here:

State hit with $12M judgment after rookie trooper arrests stroke victim

An Essex County jury has handed down a $11.5 million verdict against a New Jersey State Police trooper who mistook a motorist’s stroke for inebriation and arrested her, delaying medical treatment so long she’s now permanently disabled.

Cheryl Rhines of Jersey City was on her way to work in October 2017 when she began feeling ill and pulled to the shoulder of a highway in Newark, according to the lawsuit her mother later filed.

The responding state trooper, Jennifer Albuja, misinterpreted Rhines’ failure to respond to commands, communicate coherently, or stand upright as intoxication — even though Albuja found no smell or sign of substance use and Rhines had facial drooping and other signs of a stroke, was dressed in business attire at 8 a.m. on a weekday, and had no prior offenses, her lawsuit says.

Albuja failed to get Rhines treatment at a hospital 5 minutes away and instead searched her car and hauled her, handcuffed, to the state police’s Somerville station, delaying treatment by two and half hours, according to the complaint.

A sergeant at the station finally called EMTs, but troopers still left Rhines shackled on the floor even after they determined she was in medical distress, her attorney, Dennis M. Donnelly, told the New Jersey Monitor.

“I don’t think the jury liked that much,” he said.

Donnelly attributed the botched police response to state troopers’ “us-versus-them militaristic mentality,” saying they approach their job as warriors instead of guardians.

“They see everybody in the public as a danger,” Donnelly said. “They treated this woman like she was a criminal when she was helpless.”

Rhines spent nearly two weeks in the hospital and another month in a rehabilitation center, her lawsuit says.

Now 56, she had to leave her job as an event planner and move in with her mother in Nashville because she’s unable to speak or understand what people say to her — a language disorder called global aphasia that’s caused by stroke-related brain damage, Donnelly said.

“Her work life and her abilities to live as a normal human being are over,” he said.

The case went through remediation, but the state’s attorneys refused to resolve the case for more than $1 million — and Rhines’ care expenses had exceeded that, Donnelly said. 

  Jurors decided the case Jan. 29 after a nearly month-long trial — and made a much higher initial finding of $19.1 million to cover Rhines’ future medical care, emotional distress, pain and suffering, and loss of income.

But they blamed 60% of Rhines’ disabilities on the delayed treatment and 40% on the stroke itself, which the trooper didn’t cause. So they reduced their initial award by 40%, following Superior Court Judge Thomas Vena’s guidance.

State police spokespeople did not respond to a request for comment Wednesday. Allison Inserro, a spokeswoman for the state Attorney General’s Office, declined to comment on the case or whether the agency had tweaked policies or training in response.

Donnelly said Albuja, who had been a trooper for only two years when she arrested Rhines, was counseled by her supervisors about the incident — but only after he sued the state on Rhines’ behalf in 2019.

A $11.5 million payout is unusually high for lawsuits filed against the state. In 2023, when the state paid out $121 million to settle 364 claims, only 23 resulted in payouts of over $1 million, according to a recent New Jersey Monitor analysis.

Ind. stroke survivor, considered intoxicated by police, pushes awareness for first responders

 It is YOUR RESPONSIBILITY  to have the proper stroke indicators(drooping smile, inability to lift arm). You can't do the slurred speech or dizziness one either.

 What is your stroke hospital misdiagnosis rate on strokes?

Have they prevented these problems from happening?

Auckland man dies from stroke after being misdiagnosed with a migraine

 

Factors Associated with Stroke Misdiagnosis in the Emergency Department: A Retrospective Case-Control Study

 

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

 

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

 

Younger Stroke Patients Often Misdiagnosed

 

 Among 821 consecutive patients admitted to an acute stroke unit, the initial diagnosis of stroke proved incorrect in 108 (13%)

 

The latest here:

Ind. stroke survivor, considered intoxicated by police, pushes awareness for first responders

VALPARAISO, Ind. — Pat Ingram remembers leaving a Valparaiso Noon Kiwanis meeting held at First Christian Church a little more than a year ago but after that, things got fuzzy.

The Valparaiso woman, 67, has vague memories of someone tapping on the window of her car, which she pulled into a snow bank in the parking lot of a pediatrician’s office a few blocks west of the church. She recalls the cold of metal handcuffs around her wrists and seeing her husband Steve and son Aaron when she was placed in an ambulance.

And Ingram remembers waking up hours later, early the morning of Jan. 18, 2024, at Community Hospital in Munster and subsequently finding out that she had had a stroke and undergone emergency brain surgery.

For the most part, Ingram has recovered from the stroke and has been able to piece together what happened on Jan. 17 of last year. What she and her husband Steve are still unable to understand is why Valparaiso Police officers who responded to the scene spent so much time focusing on whether she was intoxicated without evaluating her for a stroke.

“We would have loved to meet with the city two weeks after this happened,” Steve Ingram said, adding they would have liked an apology and assurance from officials that police were properly trained to recognize the symptoms of a stroke.

Per an email from Patrick Lyp, Valparaiso’s city attorney, all of the city’s police officers receive “general first aid training and basic life support as part of their initial recruitment and basic training instruction,” as well as training on CPR, the use of AEDs and the administration of the opioid antidote naloxone, and other measures.

“Many officers decide to extend their basic medical response knowledge, to include the certifications of Emergency Medical Responder (EMR) or Emergency Medical Technician (EMT). The Valparaiso Police Department currently has 16 EMR-certified officers and three EMT-certified officers,” Lyp said in the email. The training, which ranges from 80 to 160 hours depending on the level of certification, addresses patients suffering from strokes.

“Within the past year, the Valparaiso Police Department has completed refresher training in medical response, to include CPR, AED, and patient assessment,” Lyp said in the email. “Additional officers have been added to the Emergency Medical Response team, as certification in this area is extremely important to the well-being of our community. VPD continues to offer training courses biennially to increase the number of officers who have this expertise.”

Police officers in Indiana are required to have training in Basic Life Support and Basic First Aid as part of their initial training, Lyp said, adding that training is set forth by department and may include specialty training and/or refresher training in those basic skills.

“VPD was the first law enforcement agency in Porter County to incorporate an emergency medical specialty, starting the program in 2020,” Lyp said.

Because Pat Ingram filed a tort claim notice, indicating the possible filing of a lawsuit, Lyp said there were limitations on how the city could respond to media questions.

Attorney Jessica Smithey filed the tort claim notice on June 4.

“Patricia’s No. 1 goal has always been to have a conversation about what occurred and what she went through,” Smithey said, adding she filed a notice of tort claim act “to preserve Patricia’s rights moving forward.”

The Ingrams note that Pat’s car came to rest in a physician’s parking lot and the Valparaiso Medical Center, a facility that’s part of the Northwest Health system, was directly across the street.

“This would have turned out differently if a firefighter had pulled up instead of a cop,” Steve Ingram said.

The Ingrams have lived in Valparaiso since 1987 and have long been active in the community.

“I dislike doing this because I love this city,” Pat Ingram said.

Ingram’s ordeal was captured on police body and squad car cameras; the couple paid the requisite fee of $150 per video, for a total of $750, per the invoice, to the police department to get the footage a week after she had the stroke.

One of those videos is about an hour long and begins as an officer is on his way to the parking lot of Associated Pediatricians at 1111 E. Glendale Boulevard for a call of “a possibly intoxicated subject,” according to the police report, and ends when she is placed in an ambulance headed to Northwest Health-Porter. She was later transported by medical helicopter to Munster .

Throughout much of the video, Pat Ingram speaks so softly that when she speaks at all, she is difficult to hear or understand. She appears confused by instructions she receives from police to lower her car radio and step out of her car, and is unsteady on her feet.

When police transport her to the sallyport at the police station and take her out of the squad car to again try to assess what’s going on, an officer hands her a pad of paper and a pen to write down where she had been before she crashed into the snowbank on but Ingram is unable to hold the objects in her right hand. Sometimes, she sighs and closes her eyes instead of responding to officers.

They ask her numerous times if she’s had a drink; she answers yes then later says no. They ask if she’s on any medication and she says no, unable to communicate that, according to her and her husband, she’s on an assortment of medications for various health issues. Police ask if Pat Ingram is diabetic; again, she is not able to articulate what’s going on.

Police appear genuinely puzzled by her condition. Once they make contact with Steve Ingram and call for an ambulance while they’re in the police department’s sallyport, first responders deduce she’s having a stroke.

Pat Ingram told her husband she was getting groceries ahead of a predicted snowstorm after the Kiwanis meeting, which wrapped up around 1:15 p.m. or so. When Steve Ingram couldn’t reach her on her cellphone after repeated attempts, he called their son.

10 Critical questions when treating a stroke

 You can critique these yourself, for those that follow me it will be easy to see the holes.

10 Critical questions when treating a stroke

A stroke is a potentially treatable “brain attack”, but only when doctors know exactly what type of stroke has been suffered and what treatment is best as a result

Globally every two seconds someone has a stroke. Being a potentially treatable “brain attack”, when the brain is deprived of blood because a blood vessel has burst or is blocked, stroke requires rapid diagnosis, transfer to hospital and treatment.

One size doesn’t fit all in stroke medicine: doctors need to tailor the treatment, according to what has happened inside the brain, and when.

Stroke or something else?

Many conditions mimic stroke and misdiagnosis is common. Up to 40 per cent of patients admitted to hospital with suspected stroke have an alternative diagnosis, including migraine, seizure, vertigo, multiple sclerosis or a brain tumour. 

Misdiagnosis is common as many conditions mimic strokes

Sometimes, symptoms of a previous stroke can return, when the survivor suffers an illness like pneumonia or a bladder infection—but there’s no new brain injury requiring treatment. “It’s as if the stress of the new problem causes the brain to forget what it learned to compensate for the disabilities of the old stroke,” writes neurologist and stroke researcher Dr John Marler, in his book Stroke for Dummies. 

Red or white? 

Dr Marler classifies stroke into two categories. So-called “red strokes” are caused when a blood vessel bursts inside the brain or, rarely, just outside, in something known as a subarachnoid haemorrhage—leaking blood, and turning the brain from pink to red. These are a less common type of stroke, but often more serious. 

"Treatment is very different for red or white stroke"

“White strokes” account for 85 per cent of all strokes, and involve a blood clot blocking an artery, cutting off blood supply. Brain tissue, deprived of blood, dies and turns from pink to white. Treatment is very different for red or white stroke. 

Passing or permanent?

Whether it’s facial droop, arm weakness, speech problems, or something else, such as headache or dizziness—if symptoms clear within a matter of minutes or within 24 hours, you may have had what is known as a “mini-stroke” or transient ischaemic attack. Take it seriously, for your next stroke may not be transient: nearly one in five people who have had a TIA go on to have a stroke within 90 days. Repeated TIAs, meanwhile, may lead to dementia, as damage accumulates in the brain. 

Treatment after TIA involves a combination of lifestyle changes, medication (especially aspirin) and, in some cases, surgical removal of the fatty deposits in your carotid arteries, which are the main vessels bringing blood to the brain.

Big or small?

Blood clots and brain arteries come in different sizes—and stroke’s impact on the brain can be more catastrophic when a major artery is affected. Doctors survey the severity of your symptoms (before scanning the brain) to work out which arteries might be affected, and so which need treatment. 

Doctors assess the severity of symptoms before scanning the brain

Sometimes though, there’s back-up blood flow from a different part of the brain, through branches of other arteries, and the origin of your stroke is less obvious in your symptoms. Other times, a patient can present with severe disability when only a small artery has blocked or burst, but in a very critical part of the brain. 

Clot buster or corkscrew?

Or vacuum cleaner! These are all ways (at the microscopic level) to treat strokes caused by clots. Clot buster drugs dissolve the clot and restore brain blood flow. Tiny devices inserted into brain arteries (having entered the body through a blood vessel in the groin and been pushed upwards) can suck the clot out, or corkscrew into it and pull it loose. Recovery can be dramatic, with paralysed limbs sometimes starting to move as the clot is suctioned out.  

Delving deep into arteries to clear clots has been proven to work in trials, including the landmark (and brilliantly-named) MR CLEAN study. Its results received a standing ovation at the World Stroke Congress in Istanbul in 2014. 

Awake or asleep?

The trouble with clot buster drugs is that they need giving within the first few hours of the stroke striking. As time passes, the stroke has done its damage and the risk of the drug causing a bleed (a known side-effect) then exceeds the benefit of busting the clot. The Oxford Handbook of Stroke Medicine states that, when using these drugs, “the onset of stroke must be known, or must be deducible, to be definitely within four and a half hours”. 

"One in five strokes happen during sleep [and] there is no way to know when the stroke happened"

But one in five strokes happen during sleep. Upon waking, there is no way to know when the stroke happened. Clot-busting drugs cannot be given, unless sleep lasted less than four and a half hours. Aspirin is likely to be prescribed instead. 

Blood pressure—how low to go?

Treating red strokes is of course very different to treating strokes caused by clots. Giving clot-busting drugs after brain haemorrhage would worsen the bleed and could be catastrophic. 

Reducing blood pressure through medication can sometimes worsen stroke damage

Reducing blood pressure, through medication, to slow the flow of blood from the ruptured artery (like turning down the tap to a leaky hose) may seem like a good idea, and trials named CHIPPS and INTERACT support this. But going too low with blood pressure risks reducing blood flow to the brain, worsening the damage. A “watch and wait” approach is recommended by doctors, unless blood pressure is very high on admission. 

Clips or coils?

When there’s a bleed on the surface of the brain, its origin is often a weak spot resembling a “burst balloon” in the wall of an artery, known as an aneurysm. Repairing this, to stem the flow and prevent further bleeds, is no mean feat. 

Metal clips, resembling tiny ice tongs, can close off the neck of the aneurysm (rather like tying a knot at the base of a balloon). Getting there though requires an opening being made in the skull. 

An alternative is to go through the groin (as with the vacuum cleaners and corkscrews), and instead send hair-width pieces of platinum up through blood vessels, twisting and turning until they reach the brain. These spring into coils within the aneurysm, blocking blood flow and bleeding.

Treating the cause or consequence?

After medical treatment for your burst or blocked artery, an entire team of health care professionals will be assigned to treat the consequences of your stroke, in a programme of stroke rehabilitation.

"Recovery can continue for months and years after stroke"

Up to 70 per cent of stroke survivors have altered speech—whether slurred, slowed (in word production or understanding) or softened. Speech and language therapists can help, paying attention also to possible swallowing problems, which can raise your risk of choking.

Help is also at hand to treat post-stroke pain, fatigue, muscle tightness or weakness, incontinence, pressure sores, and possible visual problems. Recovery can continue for months and years after stroke. 

Mind or body?

The psychological impact of stroke can be as noticeable as the physical. Emotions such as laughing or crying can be hard to control. In a recognised post-stroke condition known as emotionalism; anxiety, frustration, anger and depression are also common. The Stroke Association assures survivors that things do get better—with time, talking therapies, taking it easy on yourself, and medication. 

Celebrate the small successes in your recovery—or the really big ones. Composer George Frideric Handel wrote his most renowned work, Messiah, after a stroke at the age of 52, whilst living with deep depression.

Diagnostic Errors in the Emergency Department: A Systematic Review

 What is your stroke hospital misdiagnosis rate on strokes?

Have they prevented these problems from happening?

Auckland man dies from stroke after being misdiagnosed with a migraine

 

Factors Associated with Stroke Misdiagnosis in the Emergency Department: A Retrospective Case-Control Study

 

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

 

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

 

Younger Stroke Patients Often Misdiagnosed

 

 Among 821 consecutive patients admitted to an acute stroke unit, the initial diagnosis of stroke proved incorrect in 108 (13%)

 

The latest here:

Diagnostic Errors in the Emergency Department: A Systematic Review

• Overall diagnostic accuracy in the emergency department (ED) is high, but some patients receive an incorrect diagnosis (~5.7%). Some of these patients suffer an adverse event because of the incorrect diagnosis (~2.0%), and some of these adverse events are serious (~0.3%). This translates to about 1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death. These rates are comparable to those seen in primary care and hospital inpatient care.
• We estimate that among 130 million emergency department (ED) visits per year in the United States that 7.4 million (5.7%) patients are misdiagnosed, 2.6 million (2.0%) suffer an adverse event as a result, and about 370,000 (0.3%) suffer serious harms from diagnostic error. Put in terms of an average ED with 25,000 visits annually and average diagnostic performance, each year this would be over 1,400 diagnostic errors, 500 diagnostic adverse events, and 75 serious harms, including 50 deaths per ED. Although overall error and harm rates are derived from three smaller studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758), study methods were prospective and rigorous. All three were conducted at university hospitals, and, for the two studies used to estimate harms, about 92 percent of clinicians under study at those institutions had full training or formal certification in emergency medicine.
• Five conditions (#1 stroke, #2 myocardial infarction, #3 aortic aneurysm/dissection, #4 spinal cord compression/injury, #5 venous thromboembolism) account for 39 percent of serious misdiagnosis-related harms, and the top 15 conditions account for 68 percent. Variation in diagnostic error rates by disease are striking (range 1.5% for myocardial infarction to 56% for spinal abscess, with the other thirteen falling between 10% and 36%). Stroke, the top serious harm-producing disease, is missed an estimated 17% of the time. Among these 15 diseases, myocardial infarction is the only one with false negative rates near zero (1.5%), well below the estimated average rate across all diseases (5.7%).
• For a given disease, nonspecific or atypical symptoms increase the likelihood of error. For stroke, dizziness or vertigo increases the odds of misdiagnosis 14-fold over motor symptoms (those with dizziness and vertigo are missed initially 40% of the time).
• Variation in diagnostic error rates across demographic groups is present and sometimes fairly large in magnitude. The effect of age is heterogeneous and disease-specific (e.g., younger age increases risk of missed stroke 6.7-fold, while older age increases risk of missed appendicitis). Female sex and non-White race were often associated with important (20–30%) increases in misdiagnosis risk; although these disparities were inconsistently demonstrated across studies, being a woman or a racial or ethnic minority was generally not found to be "protective" against misdiagnosis (i.e., was neutral at best).
• Variation in diagnostic error rates across specific hospital EDs is wide. Methods of measuring diagnostic errors in the ED are highly variable. However, even when similar methods are used, measured diagnostic error rates vary up to 100-fold across hospitals. In individual studies, missed cases varied by hospital for subarachnoid hemorrhage (0% to 100%), myocardial infarction (0% to 29%), and appendicitis (1% to 16%). Error rates are usually found to be lower in academic/teaching hospitals, but it is unknown if this is an effect of increased availability/intensive use of diagnostic technologies or other factors.
• Root causes of ED diagnostic errors were mostly cognitive errors linked to the process of bedside diagnosis. Malpractice claims associated with serious misdiagnosis-related harms involved failures of clinical assessment, reasoning, or decision making in about 90 percent of cases. Similar findings were seen in incident report data. These issues are not unique to the ED—they are seen across clinical settings, regardless of study method.
• The strongest, most consistent predictors of ED diagnostic error were individual case factors that increased the cognitive challenge of identifying the underlying disorder, with nonspecific, mild, transient, or "atypical" symptoms being the most frequent.
• Our findings are tempered by limitations in the underlying evidence base, including issues related to data sources, measurement methods, and causal relationships. Nevertheless, overall diagnostic error and misdiagnosis-related harm rates are consistent with what has been found in other clinical settings (e.g., primary care and inpatient).

‘Doesn’t Look Like He Needs an Ambulance’: 17-Year-Old Boston Student Has Stroke In Class. School Nurse Argues with His Mom to Pick Him Up Instead of Calling 911

Obviously the problem was the patient did not have enough of the classic stroke symptoms. Just another misdiagnosis of young adult strokes. The solution is to not have a stroke while young, wait until you are old and decrepit.

When you have your stroke as a young adult you will be required to have a partner to advocate strenuously to consider stroke as a distinct possibility. So plan your stroke accordingly.

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

Younger Stroke Patients Often Misdiagnosed

 

 Among 821 consecutive patients admitted to an acute stroke unit, the initial diagnosis of stroke proved incorrect in 108 (13%)

The latest here:

‘Doesn’t Look Like He Needs an Ambulance’: 17-Year-Old Boston Student Has Stroke In Class. School Nurse Argues with His Mom to Pick Him Up Instead of Calling 911

 

A 17-year-old Boston high school student suffered a stroke while in class but did not receive the medical assistance he needed after officials called his mother instead of 911.

D’Andre Hicks with his mother. (CBS Local Video Screengrab)

The teen’s mother, who is wheelchair-bound, is furious, asking why the school nurse did not recognize the signs of his health failing when the boy complained about feeling tired and his side felt numb.

D’Andre Hicks, a junior at the Henderson Inclusion (Upper School) in Dorchester, Mass, became ill while under the school’s supervision in early May 2022.

After telling his school nurse he felt “weak,” “shaky,” and “numb,” she called his mother Alishia Hicks to pick him up from the school, ignoring the signs suggesting the boy was having a stroke and the mother’s request to get more immediate assistance for her child.

“He came to the nurse’s office to report that he was feeling weak, shaky and that he felt numb weakness on his left side,” the mother said.

She recalled telling her nurse, “He’s going to die if he’s stroking, they’re taking too long to dial 911.”

Alishia argues the school’s top medical professional should have considered first responders who would have gotten to the boy first, noting her proximity to the school and inability to move fast because she is confined to a wheelchair.

Instead, the nurse told the mom, “Well, my professional, my medical evaluation, it doesn’t look like he needs an ambulance, somebody should come pick him up.”

Eventually, the school called 911, who arrived 30-45 minutes after the initial call to the mother — despite the teen remaining in crisis. The call was made after the school reached out to the Department of Children and Families because the mom didn’t come immediately.

“You could hear the other one in the background,” Alishia recalled. “The other nurse said to call DCF.”

Once an ambulance showed up, the young man was taken to Tufts Medical Center where he was diagnosed as having an acute ischemic stroke. The doctors stopped the stroke using medication but kept the child for two days.

The mother knew it all along, saying, “Even I know the symptoms of a stroke. Why didn’t the nurse?”

Boston 25 News reports Alishia, herself, has had three strokes in her life. She further explained her family has a history of strokes.

“Listen there’s a small vessel problem on my mother’s side of the family that causes a stroke easily if there’s any blockage in it is so important to get him to the hospital right away because he could die,” she shared.

“Your professional eye may not see the stroke,” Alishia said as she tried to communicate. “It’s not visible but if he’s telling you he is weak on his left side, please, at this point I’m pleading with all intensity that I could muster up with no voice. Please get my son to the hospital, please.”

D’Andre said, “They start arguing with her on that while I’m out here stroking on the bed right now trying to stay up. I was afraid that if I fell asleep or something like that I was going to go into a coma or probably for the worst.”

His mother says, “He’s not happy about the school right now he doesn’t feel safe there. His words when he was in the hospital, he said ‘Mom I can’t believe they didn’t believe me.’”

Boston School Superintendent Brenda Cassellius personally reached out to the mother to apologize; Alishia shared. Cassellius told her the district is already reviewing the incident.

In a statement released by the Boston Public Schools, officials wanted to make clear their first concern is “first with the health and well-being of this student.”

“We are glad to hear he is recovering well,” it continued in part. “This serious incident is being reviewed by appropriate BPS staff and therefore it would be inappropriate to comment further on this specific matter.”

While the mother acknowledged the Superintendent’s outreach, she could not help but think race played a part in the school’s response.

Her thoughts about race and medical care are in line with a recent study put out by the American Bar Association about “Implicit Bias and Racial Disparities in Health Care.” They claim, “Black people simply are not receiving the same quality of health care that their white counterparts receive.” Her son is evidence of this.

The school also released a statement to the student body’s families informing them about the paramedics coming to the campus. Instead of referencing D’Andre’s plight, they shared with the parents that paramedics were called to support a student having a diabetic episode.

Neither the school nor DCF released a public statement, but have confirmed the Hicks incident is being investigated.

No word on if the family will be filing a civil rights lawsuit, alleging his rights were violated.

AHA News: Revised Scale Could Lead to Timelier Treatment for Strokes in the Back of the Head

 This might help all those young adult strokes which are dismissed as drunkeness or being high. So until this gets rolled out to your hospital it is your responsibility to have a frontal lobe stroke with all the classic symptoms.

AHA News: Revised Scale Could Lead to Timelier Treatment for Strokes in the Back of the Head

By American Heart Association News, HealthDay Reporter

(HealthDay)

WEDNESDAY, Dec. 15, 2021 (American Heart Association News) -- A tool widely used by doctors to help determine who needs clot-busting therapy after a stroke has some missing pieces, according to new research that suggests adding a few simple tests could help improve treatment for people who have less common strokes in the back of the brain.

Published Wednesday in the American Heart Association journal Stroke, the study shows modifying the National Institutes of Health Stroke Scale to include tests for symptoms that occur when people have posterior circulation strokes could identify more people with potentially disabling symptoms in need of immediate treatment who may not be getting it.

"The current stroke scale that is widely used is biased towards anterior circulation strokes, those involving the arteries supplying the front of the brain," said Dr. Amytis Towfighi, a professor of neurology and population and public health sciences at the University of Southern California Keck School of Medicine in Los Angeles. She was not involved in the new research. "It does not accurately represent the severity of posterior circulation strokes because it does not test for key deficits seen in those strokes."

Posterior circulation strokes occur in the back of the brain and are less common, accounting for roughly 1 in 5 ischemic (clot-caused) strokes. But people who have them are at higher risk of severe stroke, becoming disabled or dying.

The NIH Stroke Scale, considered the standard for evaluating stroke severity, is used to identify a level of risk for post-stroke disabilities that helps determine who would benefit from so-called reperfusion treatments such as drugs used to break up blood clots or non-invasive surgery to remove them. Doctors use the scale to assess and help determine what treatment is needed using a series of tests to gauge the potential severity of stroke symptoms.

But those tests focus on symptoms common in front-of-the-head strokes, such as weakness in the arms and legs or trouble speaking. People with back-of-the-head strokes, on the other hand, may experience additional problems with balance, dizziness, coordination, swallowing or headache.

Some of those symptoms are not assessed by the current stroke scale, said lead study author Dr. Fana Alemseged, a neurologist and research fellow in the department of medicine and neurology at Royal Melbourne Hospital in Australia.

As a result, people with posterior strokes end up with lower scores on the assessment scale that suggest they don't need reperfusion therapies. But, she said, "time is brain! Roughly 2 million neurons die each minute. So, withholding or delaying therapy because of an inaccurate clinical assessment could lead to long-term disability in stroke patients."

Permanent brain damage can occur if blood supply is not restored to the brain, Alemseged said. "Patients with posterior circulation stroke not treated with reperfusion therapies can have residual symptoms such as limb weakness and speech problems, visual disturbances, memory issues, coordination or balance problems and difficulty swallowing that can affect their activities of daily living."

Preliminary research presented earlier this year at the AHA's International Stroke Conference found people who experience posterior strokes are far less likely to receive treatment to dissolve or remove clots than those who have strokes at the front of the brain.

The new study found people with posterior circulation strokes who scored low on the stroke scale were more likely to be disabled than people with anterior circulation strokes – showing that up to 40% of those patients experience lingering disabilities at three months.

Alemseged and her team modified the NIH Stroke Scale to include assessments for balance or walking difficulties and problems coughing or swallowing.

In the study, people who could stand were asked to do so for a few seconds and then walk naturally. If they had muscle weakness, balance was tested by asking them to sit up in bed and observing whether they were able to do so without assistance.

Towfighi said people experiencing a stroke are not routinely tested for balance issues because of safety concerns, since they may be too weak to stand or could fall over.

"It's a little hard to test balance in an acute setting," said Towfighi, who is also chief of neurology and associate medical director of research at the Los Angeles County+USC Medical Center.

Alemseged's research used the new modified model to assess patients who scored low on the traditional scale following posterior strokes and found 17% of them (36 people out of 213) would potentially not have been considered for treatment even though they had possible disabling symptoms. Alemseged said more and larger studies are needed to confirm her team's results.

Towfighi said finding a way to identify people with posterior strokes who need treatment is long overdue.

"It's been over 20 years that we've been using this scale," she said, "and people have acknowledged the limitation for years. This research provides simple straightforward tests which have the potential of enhancing outcomes in scores of patients."

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email editor@heart.org.

By Laura Williamson

Copyright © 2021 HealthDay. All rights reserved.

A man collapsed with life-threatening brain bleeding in a karaoke bar — but doctors almost sent him home because they assumed he was drunk

When you have your stroke as a young adult you will be required to have a partner to advocate strenuously to consider stroke as a distinct possibility. So plan your stroke accordingly.

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

Younger Stroke Patients Often Misdiagnosed

 

 Among 821 consecutive patients admitted to an acute stroke unit, the initial diagnosis of stroke proved incorrect in 108 (13%)

Amy on her 36 hour wait for a diagnosis.

The latest here:

A man collapsed with life-threatening brain bleeding in a karaoke bar — but doctors almost sent him home because they assumed he was drunk

Anna Medaris Miller

Fri, November 19, 2021, 11:48 AM·4 min read

In this article:

Drew Magary in the hospital soon after he was able to feed himself again. He'd lost 30 pounds in 2 weeks.Courtesy of Drew Magary

• Drew Magary had only had a beer or two before collapsing, vomitting, bleeding, and slurring.

• Clinicians almost dismissed him as drunk, but he'd experienced a life-threatening brain bleed.

• Magary writes about learning to live with a traumatic brain injury in "The Night the Lights Went Out."

Drew Magary wasn't one to turn down a drink. His wife's go-to Christmas present for him was a bottle of nice booze, and the Deadspin journalist typically pregamed hosting gigs with a few cocktails because, well, he could.

But one December 2018 night in New York City, the Maryland-based father of three uncharacteristically abstained from alcohol before delivering a monologue for his magazine's tongue-in-cheek awards ceremony.

So when he collapsed, began bleeding profusely, vomiting, and mumbling nonsense early into the afterparty, his friends knew something was really wrong. And yet, clinicians brushed it off as drunkenness and nearly discharged him with severe brain bleeding, his friends told him later.

Magary, now 45 and still coping with the long-term effects of traumatic brain injury, describes his experiences in the new book, "The Night the Lights Went Out." He's not the only young person with a life-threatening illness to be dismissed by medical professionals under the assumption of inebriation.

Magary's colleagues fought for an MRI that likely saved his life

Magary doesn't remember anything between going to the afterparty at a karaoke bar and waking up from a medically-induced coma two weeks later. For the book, he interviewed his colleagues who witnessed most of it.

One, Jorge Corona, said he "felt a thud" before seeing Magary on his back with his hands curled up to his chest and "slick, deep blood" behind his head.

Another colleague, Kiran Chitanvis, called 911. "The EMTs seemed convinced ... that you were just very drunk," Chitanvis said. Rather than putting Magary in a stretcher, he said, they tried to make Magary walk.

In the emergency room, doctors tried to send Magary home, the book reports. "The doctors and nurses were being so blasé about it, I started to doubt myself and I was like, Okay, maybe he is drunk," Megan Greenwell, then Deadspin's editor-in-chief, told Magary.

But she insisted on an MRI. Results showed blood was seeping through cracks in Magary's skull. He'd suffered a brain hemorrhage that was on track to kill him, he writes.

His blood alcohol level was 0.016 — reflective of less than one beer.

He was in coma for 2 weeks

Magary was intubated and sent to another New York hospital better equipped to deal with brain trauma. He underwent an emergency surgery involving holes being drilled into his skull to stop the bleeding and drain the fluid buildup.

Typically, the surgeon said, if patients like Magary aren't in surgery within four hours, they have "no chance of living." Magary's surgery was over six hours after his collapse.

While Magary survived, his life is forever changed. He lost hearing in one ear, much of his sense of taste and smell, some of his memory, and thousands of dollars. He went from exhuberant to so unpredictably cranky that, at one point, his kids began to fear him.

"The more I tried to be that Other Drew, the more frustrated I became," Magary wrote. "I had to give in. I had to understand that my injury had not only changed me but also changed everyone I loved."

Drew Magary today.Courtesy of Drew Magary

Other young people have been dismissed with serious conditions

While Magary's book focuses on his experiences learning to live with disability, not his interactions with healthcare professionals who his friends say blew him off, that part of his story isn't unique.

Brittany Scheier previously told Insider about waking up in the middle of the night with extreme nausea the day after celebrating her 27th birthday at wineries. She couldn't move the right side of her body, stand up, or reach for things. Her vision narrowed to a pinprick.

But in the emergency room, doctors kept asking: "Did you do drugs? It's OK [if you did],'" Scheier said. They almost sent her home. But Scheier had suffered two strokes, and doctors didn't know if she would survive. Scheier is now advocating for young women to speak up for themselves and know the signs of stroke.

"So many times I hear, 'I was listening to the doctor. Maybe they're right,'" Dr. Suzanne Steinbaum, an American Heart Association Go Red for Women volunteer medical expert, previously told Insider about Scheier's story. "No one knows our bodies as well as we do. Nobody is living in our bodies. We know when we're not OK."

Read the original article on Insider

 

Stroke in young adults: Current trends, opportunities for prevention and pathways forward

The first problem you have to solve is the misdiagnosis of young adult strokes, you don't even consider the primary problem. 

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

 

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

 

Younger Stroke Patients Often Misdiagnosed

 

 Among 821 consecutive patients admitted to an acute stroke unit, the initial diagnosis of stroke proved incorrect in 108 (13%)

 

Amy on her 36 hour wait for a diagnosis.

 

The latest here:

Stroke in young adults: Current trends, opportunities for prevention and pathways forward

Author links open overlay panelTamerYahya^aMohammad HashimJilani^bSafi U.Khan^cReedMszar^dSyed ZawahirHassan^aMichael J.Blaha^eRonBlankstein^fgSalim S.Virani^hiMichelle C.Johansen^jFarhaanVahidy^kMiguelCainzos-Achirica^akKhurramNasir^ak

https://doi.org/10.1016/j.ajpc.2020.100085Get rights and content

Under a Creative Commons license

open access

Abstract

Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20–44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and loss of productivity, all of which have vast personal, social and economic implications. These concerning trends among young adults are likely due to increasing trends in the prevalence of modifiable risk factors amongst this population including hypertension, hyperlipidemia, obesity and diabetes, highlighting the importance of early detection and aggressive prevention strategies in the general population at early ages. In parallel and compounding to the issue, troublesome trends are evident regarding increasing rates of substance abuse among young adults. Higher rates of strokes have been noted particularly among young African Americans, indicating the need for tailored prevention and social efforts targeting this and other vulnerable groups, including the primordial prevention of risk factors in the first place, reducing stroke rates in the presence of prevalent risk factors such as hypertension, and improving outcomes through enhanced healthcare access. In this narrative review we aim to emphasize the importance of stroke in young adults as a growing public health issue and increase awareness among clinicians and the public health sector. For this purpose, we summarize the available data on stroke in young adults and discuss the underlying epidemiology, etiology, risk factors, prognosis and opportunities for timely prevention of stroke specifically at young ages. Furthermore, this review highlights the gaps in knowledge and proposes future directions moving forward.

 

Safer Stroke-Dx Instrument: Identifying Stroke Misdiagnosis in the Emergency Department

You are still relying on persons to analyze this. Why? At a ≈9% failure diagnosis rate you better have the complete standard stroke effects so you get diagnosed properly. Your responsibility, not your doctors.

Get human opinions out of it.

Maybe you want these much faster objective diagnosis options.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds; February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

Ski-Mask Design AIR Coil Offers Whole-Brain Imaging Without Claustrophobia

The latest here:

Safer Stroke-Dx Instrument: Identifying Stroke Misdiagnosis in the Emergency Department

Faddi G. Saleh Velez

,

Ronald Alvarado-Dyer

,

Camila Bonin Pinto

,

Jorge G. Ortiz García

,

Daryl Mchugh

,

Jenny Lu

,

Oleg Otlivanchik

,

Brent L. Flusty

,

Ava L. Liberman

,

Shyam Prabhakaran

Originally published24 Jun 2021https://doi.org/10.1161/CIRCOUTCOMES.120.007758Circulation: Cardiovascular Quality and Outcomes. ;0:CIRCOUTCOMES.120.007758

Abstract

Background:

Missed or delayed diagnosis of acute stroke, or false-negative stroke (FNS), at initial emergency department (ED) presentation occurs in ≈9% of confirmed stroke patients. Failure to rapidly diagnose stroke can preclude time-sensitive treatments, resulting in higher risks of severe sequelae and disability. In this study, we developed and tested a modified version of a structured medical record review tool, the Safer Dx Instrument, to identify FNS in a subgroup of hospitalized patients with stroke to gain insight into sources of ED stroke misdiagnosis.

Methods:

We conducted a retrospective cohort study at 2 unaffiliated comprehensive stroke centers. In the development and confirmatory cohorts, we applied the Safer Stroke-Dx Instrument to report the prevalence and documented sources of ED diagnostic error in FNS cases among confirmed stroke patients upon whom an acute stroke was suspected by the inpatient team, as evidenced by stroke code activation or urgent neurological consultation, but not by the ED team. Inter-rater reliability and agreement were assessed using interclass coefficient and kappa values (κ).

Results:

Among 183 cases in the development cohort, the prevalence of FNS was 20.2% (95% CI, 15.0–26.7). Too narrow a differential diagnosis and limited neurological examination were common potential sources of error. The interclass coefficient for the Safer Stroke-Dx Instrument items ranged from 0.42 to 0.91, and items were highly correlated with each other. The κ for diagnostic error identification was 0.90 (95% CI, 0.821–0.978) using the Safer Stroke-Dx Instrument. In the confirmatory cohort of 99 cases, the prevalence of FNS was 21.2% (95% CI, 14.2–30.3) with similar sources of diagnostic error identified.

Conclusions:

Hospitalized patients identified by stroke codes and requests for urgent neurological consultation represent an enriched population for the study of diagnostic error in the ED. The Safer Stroke-Dx Instrument is a reliable tool for identifying FNS and sources of diagnostic error.

 

 

Imaging in acute ischaemic stroke: pearls and pitfalls

Except that the problem of misdiagnosis is usually the neurologist. So  get away from needing the neurologist, it will be much faster anyways. 

The current unacknowledged diagnosis problems. 

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

 

Doctors tell boy, 15, he had a migraine after rugby tackle - but he was actually suffering a paralyzing stroke which nearly killed him

 

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

 

Amy on her 36 hour wait for a diagnosis.

 

These much faster options are available to diagnose stroke, do you know of them?

Maybe you want these much faster objective diagnosis options.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds; February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

Ski-Mask Design AIR Coil Offers Whole-Brain Imaging Without Claustrophobia

The latest here:

 Imaging in acute ischaemic stroke: pearls and pitfalls

1. James Caldwell1,
2. Manraj K S Heran2,
3. Ben McGuinness1,
4. P Alan Barber3,4

1. Correspondence to Dr James Caldwell, Department of Neuroradiology, Auckland District Health Board, 2 Park Rd, Grafton, Auckland 1142, New Zealand; jamesrc@adhb.govt.nz

Abstract

Prompt and accurate diagnosis is the foundation of acute ischaemic stroke care. Multiple positive endovascular thrombectomy trials in ischaemic stroke patients with large vessel occlusions have further emphasised this but also added complexity to treatment decisions. CT angiography is now routine for patients who present with an acute stroke syndrome around the world. Members of the neurology and stroke teams (rather than radiologists) are often the first doctors to lay eyes on the CT images and are best equipped(Really?) to integrate the clinical picture with the imaging findings. A sound understanding of acute stroke imaging is therefore essential for clinicians who work with acute stroke patients. This review describes some pearls we have gleaned from our own experience in acute stroke imaging as well as some potential follies to be avoided.

http://dx.doi.org/10.1136/practneurol-2016-001569

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Functional Seizures Associated With Stroke, Psychiatric Disorders

 So for those diagnosed with seizures, does your doctor have the correct diagnosis and treatment?

Earlier research says this:

Following stroke, 3–6% of patients develop acute symptomatic seizures within the first 7 days

 

Post-injury epilepsy (PIE) is a devastating, unpreventable consequence of traumatic brain injury (TBI) and stroke, which develops in 10 to 40 percent of survivors months, or even years later 

 

seizures occur in about 10% of stroke patients. 

The latest here:

Functional Seizures Associated With Stroke, Psychiatric Disorders

In a large-scale study of electronic health records (EHRs), researchers have determined the prevalence of functional seizures and characterised comorbidities associated with them.

The research team, headed by Lea Davis, PhD, Vanderbilt Genetics Institute, Nashville, Tennessee, confirmed associations between functional seizures and psychiatric disorders including posttraumatic stress disorder, anxiety, and depression as well as sexual assault trauma. They also discovered a novel association between functional seizures and cerebrovascular disease, including stroke.

The findings were reported in JAMA Network Open.

About 80% of patients experiencing functional seizures are initially misdiagnosed with epilepsy and treated with anti-epileptic drugs, said Slavina Goleva, Vanderbilt University. An accurate diagnosis requires assessment with video electroencephalogram (EEG).

“We initially recognised that finding these patients within the EHR would be a challenge because the ICD [International Classification of Diseases] codes are not as specific as they are for a lot of diseases,” she said.

In addition to ICD codes, the researchers included Current Procedural Terminology (CPT) codes and used natural language processing to search within the records for a list of keywords. The researchers manually reviewed charts to confirm that the algorithm correctly identified patients with functional seizures. The study included more than 2.3 million patients aged 18 years and older in the VUMC-EHR system from 1989 to 2018. The researchers identified 3,341 patients with functional seizures, 74% of whom were women. They calculated a prevalence of 0.14% (140 cases per 100,000 people); previous estimates ranged from 2 to 33 cases per 100,000 people.

“Our report is the first direct calculation of the prevalence of functional seizures,” Goleva said, noting that the epilepsy monitoring unit at VUMC may result in a higher prevalence of functional seizures in patients in the VUMC-EHR compared with the general population.

Among the patients with functional seizures, the researchers validated comorbidities including psychiatric disorders and sexual assault trauma and discovered a novel association with cerebrovascular disease. They also found that sexual assault trauma explained about a quarter of the increased rate of functional seizures among women.

“Functional seizures are not occurring in isolation,” said Dr. Davis. “Patients who are experiencing these seizures are also experiencing a higher burden of additional healthcare issues.”

The researchers recommended that patients experiencing seizures who have psychiatric comorbidities or a history of sexual assault trauma be referred for video-EEG assessment. Patients who develop seizures after a stroke and do not initially respond to treatment with medications should also be considered for early video-EEG assessment.

Up to 30% of patients referred for video-EEG are eventually diagnosed with functional seizures, they noted.

“It’s frustrating that there is no ICD code for functional seizures, given how common the diagnosis is and the fact that codes exist for strange things like alligator bite, second occurrence,” said Dr. Davis. “It really emphasises how little attention this population of patients has gotten.”

Reference: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774486

SOURCE: Vanderbilt University Medical Center