- Among patients evaluated in the emergency department (ED) for headache, failures in diagnostic processes do not independently predict later hospitalization for stroke or transient ischemic attack (TIA).
Why this matters
- Headache is a common initial symptom among ED patients with a missed stroke diagnosis.
- Patients vs control participants:
- Older mean age (64 vs 43 years).
- Higher prevalences of traditional cerebrovascular risk factors:
- Hypertension (87% vs 38%; P<.0001>
- Diabetes (46% vs 16%; P<.0001>
- Hyperlipidemia (42% vs 17%; P=.003).
- Prior stroke/TIA (41% vs 2%; P<.0001>
- Neurological consultation (13% vs 4%; P=.03).
- Neuroimaging (80% vs 48%; P<.0001>
- Missing gait documentation (42% vs 26%; P=.03).
- Headache characteristics.
- Rates of:
- Neurological examination.
- Documented differential diagnoses.
- Clear discharge follow-up plans.
- OR, 29.01 (P=.01).
- US single-center, case-control study of adult ED patients diagnosed with primary headache disorder:
- 93 patients (hospitalization for ischemic stroke/TIA ≤365 days later).
- 93 control participants (no such subsequent hospitalization).
- Main outcome: ischemic stroke/TIA hospitalization.
- Funding: None.
- Diagnostic processes were not validated.
- Possible misclassification bias.
- Unmeasured, residual confounding.
- Uncertain generalizability.