1
|
Rapillo CM, Dunet V, Pistocchi S, Salerno A, Darioli V, Bartolini B, Hajdu SD, Michel P, Strambo D. Moving From CT to MRI Paradigm in Acute Ischemic Stroke: Feasibility, Effects on Stroke Diagnosis and Long-Term Outcomes. Stroke 2024; 55:1329-1338. [PMID: 38488367 PMCID: PMC11045552 DOI: 10.1161/strokeaha.123.045154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND The relative value of computed tomography (CT) and magnetic resonance imaging (MRI) in acute ischemic stroke (AIS) is debated. In May 2018, our center transitioned from using CT to MRI as first-line imaging for AIS. This retrospective study aims to assess the effects of this paradigm change on diagnosis and disability outcomes. METHODS We compared all consecutive patients with confirmed diagnosis of AIS admitted to our center during the MRI-period (May 2018-August 2022) and an identical number of patients from the preceding CT-period (December 2012-April 2018). Univariable and multivariable analyses were performed to evaluate outcomes, including the number and delay of imaging exams, the rate of missed strokes, stroke mimics treated with thrombolysis, undetermined stroke mechanisms, length of hospitalization, and 3-month disability. RESULTS The median age of the 2972 included patients was 76 years (interquartile range, 65-84), and 46% were female. In the MRI-period, 80% underwent MRI as first acute imaging. The proportion of patients requiring a second acute imaging modality for diagnostic ± revascularization reasons increased from 2.1% to 5% (Punadj <0.05), but it decreased in the subacute phase from 79.0% to 60.1% (Padj <0.05). In thrombolysis candidates, there was a 2-minute increase in door-to-imaging delay (Padj <0.05). The rates of initially missed AIS diagnosis was similar (3.8% versus 4.4%, Padj=0.32) and thrombolysis in stroke mimics decreased by half (8.6% versus 4.3%; Padj <0.05). Rates of unidentified stroke mechanism at hospital discharge were similar (22.8% versus 28.1%; Padj=0.99). The length of hospitalization decreased from 9 (interquartile range, 6-14) to 7 (interquartile range, 4-12) days (Padj=0.62). Disability at 3 months was similar (common adjusted odds ratio for favorable Rankin shift, 0.98 [95% CI, 0.71-1.36]; Padj=0.91), as well as mortality and symptomatic intracranial hemorrhage. CONCLUSIONS A paradigm shift from CT to MRI as first-line imaging for AIS seems feasible in a comprehensive stroke center, with a minimally increased delay to imaging in thrombolysis candidates. MRI was associated with reduced thrombolysis rates of stroke mimics and subacute neuroimaging needs.
Collapse
Affiliation(s)
- Costanza Maria Rapillo
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
- Stroke Unit, Careggi University Hospital, Florence, Italy (C.M.R.)
| | - Vincent Dunet
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Silvia Pistocchi
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Alexander Salerno
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Vincent Darioli
- Emergency Department (V. Darioli) and Interventional Neuroradiological Unit, University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Bruno Bartolini
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Steven David Hajdu
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
| |
Collapse
|
2
|
Kühne Escolà J, Bozkurt B, Brune B, Chae WH, Milles LS, Pommeranz D, Brune L, Dammann P, Sure U, Deuschl C, Forsting M, Kill C, Kleinschnitz C, Köhrmann M, Frank B. Frequency and Characteristics of Non-Neurological and Neurological Stroke Mimics in the Emergency Department. J Clin Med 2023; 12:7067. [PMID: 38002680 PMCID: PMC10672280 DOI: 10.3390/jcm12227067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Stroke mimics are common in the emergency department (ED) and early detection is important to initiate appropriate treatment and withhold unnecessary procedures. We aimed to compare the frequency, clinical characteristics and predictors of non-neurological and neurological stroke mimics transferred to our ED for suspected stroke. METHODS This was a cross-sectional study of consecutive patients with suspected stroke transported to the ED of the University Hospital Essen between January 2017 and December 2021 by the city's Emergency Medical Service. We investigated patient characteristics, preclinical data, symptoms and final diagnoses in patients with non-neurological and neurological stroke mimics. Multinominal logistic regression analysis was performed to assess predictors of both etiologic groups. RESULTS Of 2167 patients with suspected stroke, 762 (35.2%) were diagnosed with a stroke mimic. Etiology was non-neurological in 369 (48.4%) and neurological in 393 (51.6%) cases. The most common diagnoses were seizures (23.2%) and infections (14.7%). Patients with non-neurological mimics were older (78.0 vs. 72.0 y, p < 0.001) and more likely to have chronic kidney disease (17.3% vs. 9.2%, p < 0.001) or heart failure (12.5% vs. 7.1%, p = 0.014). Prevalence of malignancy (8.7% vs. 13.7%, p = 0.031) and focal symptoms (38.8 vs. 57.3%, p < 0.001) was lower in this group. More than two-fifths required hospitalization (39.3 vs. 47.1%, p = 0.034). Adjusted multinominal logistic regression revealed chronic kidney and liver disease as independent positive predictors of stroke mimics regardless of etiology, while atrial fibrillation and hypertension were negative predictors in both groups. Prehospital vital signs were independently associated with non-neurological stroke mimics only, while age was exclusively associated with neurological mimics. CONCLUSIONS Up to half of stroke mimics in the neurological ED are of non-neurological origin. Preclinical identification is challenging and a high proportion requires hospitalization. Awareness of underlying etiologies and differences in clinical characteristics is important to provide optimal care.
Collapse
Affiliation(s)
- Jordi Kühne Escolà
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Bessime Bozkurt
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Bastian Brune
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, 45147 Essen, Germany;
- Medical Emergency Service of the City of Essen, 45139 Essen, Germany
| | - Woon Hyung Chae
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Lennart Steffen Milles
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Doreen Pommeranz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Lena Brune
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (P.D.); (U.S.)
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (P.D.); (U.S.)
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany (M.F.)
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany (M.F.)
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, 45147 Essen, Germany;
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, 45147 Essen, Germany; (J.K.E.); (B.B.); (W.H.C.); (L.S.M.); (D.P.); (L.B.); (C.K.); (M.K.)
| |
Collapse
|
3
|
Mello-Thoms C, Mello CAB. Clinical applications of artificial intelligence in radiology. Br J Radiol 2023; 96:20221031. [PMID: 37099398 PMCID: PMC10546456 DOI: 10.1259/bjr.20221031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/27/2023] Open
Abstract
The rapid growth of medical imaging has placed increasing demands on radiologists. In this scenario, artificial intelligence (AI) has become an attractive partner, one that may complement case interpretation and may aid in various non-interpretive aspects of the work in the radiological clinic. In this review, we discuss interpretative and non-interpretative uses of AI in the clinical practice, as well as report on the barriers to AI's adoption in the clinic. We show that AI currently has a modest to moderate penetration in the clinical practice, with many radiologists still being unconvinced of its value and the return on its investment. Moreover, we discuss the radiologists' liabilities regarding the AI decisions, and explain how we currently do not have regulation to guide the implementation of explainable AI or of self-learning algorithms.
Collapse
Affiliation(s)
| | - Carlos A B Mello
- Centro de Informática, Universidade Federal de Pernambuco, Recife, Brazil
| |
Collapse
|
4
|
Lang YS, Zhang YZ. Diagnostic values of leukocyte, neutrophil, and neutrophil to lymphocyte ratio in distinguishing central facial paralysis from peripheral facial paralysis. Clin Neurol Neurosurg 2023; 231:107832. [PMID: 37329734 DOI: 10.1016/j.clineuro.2023.107832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/23/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Misdiagnosis of central facial palsy (CFP) as peripheral facial palsy (PFP) can lead to serious consequences clinically. It is unknown whether the leukocyte counts (leukocyte), neutrophil counts (neutrophil), and neutrophil to lymphocyte ratio (NLR) can be used to distinguish CFP from PFP. METHODS Of the total 152 patients admitted for acute facial paralysis, 76 CFP patients (CFP group) caused by acute ischemic stroke (AIS) and 76 PFP cases (PFP group) without AIS were enrolled in this retrospective study. The levels of blood leukocyte, neutrophil, lymphocyte, platelet counts (platelet), NLR, and platelet to lymphocyte ratio (PLR) before or upon admission were recorded and compared between the two groups. The student t-test was adopted for comparison of the mean. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). Comparison of AUC was performed using the Z-test. RESULTS Compared with PFP group, the levels of leukocyte, neutrophil, and NLR were significantly increased in CFP group (all p < 0.01), and there were still significantly statistical differences (all p < 0.01), even after adjusting for age, gender, and past medical history, while no significantly statistical differences of lymphocyte, platelet, and PLR were found between CFP and PFP (all p > 0.05); furthermore, the AUC in distinguishing CFP from PFP were 0.629, 0.671, and 0.657 for leukocyte, neutrophil, and NLR, respectively, and no significant difference of AUC was observed among leukocyte, neutrophil, and NLR (p > 0.05); finally, the cutoff values (specificity, sensitivity, and Youden index) in distinguishing CFP from PFP were 7.08 × 109/L (65.79%, 57.89%, 0.237) for leukocyte, 4.90 × 109/L (73.68%, 60.53%, 0.342) for neutrophil, and 2.88 (72.37%, 55.26%, 0.276) for NLR, respectively. CONCLUSIONS As easy-to-obtain and inexpensive inflammatory biomarkers, leukocyte, neutrophil, and NLR could demonstrate diagnostic values in distinguishing between CFP and PFP.
Collapse
Affiliation(s)
- Ya-Song Lang
- Department of Emergency, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Lianyungang 222000, China
| | - Yue-Zhan Zhang
- Department of Geriatrics, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Lianyungang 222000, China.
| |
Collapse
|
5
|
Poongkunran M, Ulep RD, Stuntz GA, Mitchell S, Gaines KJ, Vidal G, Chehebar D, Iwuchukwu IO, McGrade H, Mohammed AE, Zweifler RM. Diagnostic accuracy of telestroke consultation: a Louisiana based tele-network experience. Front Neurol 2023; 14:1141059. [PMID: 37333002 PMCID: PMC10273670 DOI: 10.3389/fneur.2023.1141059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background and purpose Telestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to evaluate diagnostic accuracy of telestroke consultations and explore the characteristics of misdiagnosed patients with a focus on stroke mimics. Methods We conducted a retrospective study of all the consultations in our Ochsner Health's TeleStroke program seen between April 2015 and April 2016. Consultations were classified into one of three diagnostic categories: stroke/transient ischemic attack, mimic, and uncertain. Initial telestroke diagnosis was compared with the final diagnosis post review of all emergency department and hospital data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) for diagnosis of stroke/TIA versus mimic were calculated. Area under receiver-operating characteristic curve (AUC) analysis to predict true stroke was performed. Bivariate analysis based on the diagnostic categories examined association with sex, age, NIHSS, stroke risk factors, tPA given, bleeding after tPA, symptom onset to last known normal, symptom onset to consult, timing in the day, and consult duration. Logistic regression was performed as indicated by bivariate analysis. Results Eight hundred and seventy-four telestroke evaluations were included in our analysis. Accurate diagnosis through teleneurological consultation was seen in 85% of which 532 were strokes (true positives) and 170 were mimics (true negatives). Sensitivity, specificity, PPV, NPV were 97.8, 82.5, 93.7 and 93.4%, respectively. LR+ and LR- were 5.6 and 0.03. AUC (95% CI) was 0.9016 (0.8749-0.9283). Stroke mimics were more common with younger age and female gender and in those with less vascular risk factors. LR revealed OR (95% CI) of misdiagnosis for female gender of 1.9 (1.3-2.9). Lower age and lower NIHSS score were other predictors of misdiagnosis. Conclusion We report high diagnostic accuracy of the Ochsner Telestroke Program in discriminating stroke/TIA and stroke mimics, with slight tendency towards over diagnosis of stroke. Female gender, younger age and lower NIHSS score were associated with misdiagnosis.
Collapse
Affiliation(s)
- Mugilan Poongkunran
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Robin D. Ulep
- Ochsner Clinical School, New Orleans, LA, United States
| | | | - Sara Mitchell
- Ochsner Clinical School, New Orleans, LA, United States
| | - Kenneth J. Gaines
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Gabriel Vidal
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Daniel Chehebar
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | | | - Harold McGrade
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| | - Alaa E. Mohammed
- Ochsner Center for Outcomes Research, Office of Epidemiology and Biostatistical Collaborations, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Richard M. Zweifler
- Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States
| |
Collapse
|
6
|
Sex and Gender Bias as a Mechanistic Determinant of Cardiovascular Disease Outcomes. Can J Cardiol 2022; 38:1865-1880. [PMID: 36116747 DOI: 10.1016/j.cjca.2022.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/21/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022] Open
Abstract
Defined as a prejudice either for or against something, biases at the provider, patient, and societal level all contribute to differences in cardiovascular disease recognition and treatment, resulting in outcome disparities between sexes and genders. Provider bias in the under-recognition of female-predominant cardiovascular disease and risks might result in underscreened and undertreated patients. Furthermore, therapies for female-predominant phenotypes including nonobstructive coronary artery disease and heart failure with preserved ejection fraction are less well researched, contributing to undertreated female patients. Conversely, women are less likely to seek urgent medical attention, potentially related to societal bias to put others first, which contributes to diagnostic delays. Furthermore, women are less likely to have discussions around risk factors for coronary artery disease compared with men, partially because they are less likely to consider themselves at risk for heart disease. Provider bias in interpreting a greater number of presenting symptoms, some of which have been labelled as "atypical," can lead to mislabelling presentations as noncardiovascular. Furthermore, providers might avoid discussions around certain therapies including thrombolysis for stroke, and cardiac resynchronization therapy in heart failure, because it is incorrectly assumed that women are not interested in pursuing options deemed more invasive. To mitigate bias, organizations should aim to increase the visibility and involvement of women in research, health promotion, and clinical and leadership endeavours. More research needs to be done to identify effective interventions to mitigate sex and gender bias and the resultant cardiovascular outcome discrepancies.
Collapse
|
7
|
Hall J, Kroll T, van Wijck F, Bassil-Morozow H. Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:877442. [PMID: 36189023 PMCID: PMC9397888 DOI: 10.3389/fresc.2022.877442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022]
Abstract
Background Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals. Methods This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions. Findings Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support. Conclusion Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.
Collapse
Affiliation(s)
- Joseph Hall
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
- *Correspondence: Joseph Hall
| | - Thilo Kroll
- UCD Centre for Education, Research and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Frederike van Wijck
- Research Centre for Health, School for Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Helena Bassil-Morozow
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
| |
Collapse
|
8
|
Ebrahimzadeh SA, Manzoor K, Edlow JA, Selim M, Chang YM, Bhadelia RA, Mehta P. Diagnostic yield of CT angiography performed for suspected cervical artery dissection in the emergency department. Emerg Radiol 2022; 29:825-832. [DOI: 10.1007/s10140-022-02065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022]
|
9
|
Muro-Fuentes EA, Stunkel L. Diagnostic Error in Neuro-ophthalmology: Avenues to Improve. Curr Neurol Neurosci Rep 2022; 22:243-256. [PMID: 35320466 PMCID: PMC8940596 DOI: 10.1007/s11910-022-01189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review To highlight potential avenues to reduce preventable diagnostic error of neuro-ophthalmic conditions and avoid patient harm. Recent Findings Recent prospective studies and studies of patient harm have advanced our understanding. Additionally, recent studies of fundus photography, telemedicine, and artificial intelligence highlight potential avenues for diagnostic improvement. Summary Diagnostic error of neuro-ophthalmic conditions can often be traced to failure to gather an adequate history, perform a complete physical exam, obtain adequate/appropriate neuroimaging, and generate a complete, appropriate differential diagnosis. Improving triage and identification of neuro-ophthalmic conditions by other providers and increasing access to subspecialty neuro-ophthalmology evaluation are essential avenues to reduce diagnostic error. Further research should evaluate the relationship between misdiagnosis and patient harm, and help identify the most impactful potential targets for improvement.
Collapse
Affiliation(s)
| | - Leanne Stunkel
- John F. Hardesty, MD Department of Ophthalmology and Visual Sciences and Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8096, St. Louis, MO, 63110, USA
| |
Collapse
|
10
|
Griffin JA, Carr K, Bersani K, Piniella N, Motta-Calderon D, Malik M, Garber A, Schnock K, Rozenblum R, Bates DW, Schnipper JL, Dalal AK. Analyzing diagnostic errors in the acute setting: a process-driven approach. ACTA ACUST UNITED AC 2021; 9:77-88. [PMID: 34420276 DOI: 10.1515/dx-2021-0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We describe an approach for analyzing failures in diagnostic processes in a small, enriched cohort of general medicine patients who expired during hospitalization and experienced medical error. Our objective was to delineate a systematic strategy for identifying frequent and significant failures in the diagnostic process to inform strategies for preventing adverse events due to diagnostic error. METHODS Two clinicians independently reviewed detailed records of purposively sampled cases identified from established institutional case review forums and assessed the likelihood of diagnostic error using the Safer Dx instrument. Each reviewer used the modified Diagnostic Error Evaluation and Research (DEER) taxonomy, revised for acute care (41 possible failure points across six process dimensions), to characterize the frequency of failure points (FPs) and significant FPs in the diagnostic process. RESULTS Of 166 cases with medical error, 16 were sampled: 13 (81.3%) had one or more diagnostic error(s), and a total of 113 FPs and 30 significant FPs were identified. A majority of significant FPs (63.3%) occurred in "Diagnostic Information and Patient Follow-up" and "Patient and Provider Encounter and Initial Assessment" process dimensions. Fourteen (87.5%) cases had a significant FP in at least one of these dimensions. CONCLUSIONS Failures in the diagnostic process occurred across multiple dimensions in our purposively sampled cohort. A systematic analytic approach incorporating the modified DEER taxonomy, revised for acute care, offered critical insights into key failures in the diagnostic process that could serve as potential targets for preventative interventions.
Collapse
Affiliation(s)
| | - Kevin Carr
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Maria Malik
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Ronen Rozenblum
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David W Bates
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey L Schnipper
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Anuj K Dalal
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Kühne Escolà J, Nagel S, Verez Sola C, Doroszewski E, Jaschonek H, Gutschalk A, Gumbinger C, Purrucker JC. Diagnostic Accuracy in Teleneurological Stroke Consultations. J Clin Med 2021; 10:jcm10061170. [PMID: 33799590 PMCID: PMC7998723 DOI: 10.3390/jcm10061170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The accuracy of diagnosing acute cerebrovascular disease via a teleneurology service and the characteristics of misdiagnosed patients are insufficiently known. Methods: A random sample (n = 1500) of all teleneurological consultations conducted between July 2015 and December 2017 was screened. Teleneurological diagnosis and hospital discharge diagnosis were compared. Diagnoses were then grouped into two main categories: cerebrovascular disease (CVD) and noncerebrovascular disease. Test characteristics were calculated. Results: Out of 1078 consultations, 52% (n = 561) had a final diagnosis of CVD. Patients with CVD could be accurately identified via teleneurological consultation (sensitivity 95.2%, 95% CI 93.2–96.8), but we observed a tendency towards false-positive diagnosis (specificity 77.4%, 95% CI 73.6–80.8). Characteristics of patients with a false-negative CVD diagnosis were similar to those of patients with a true-positive diagnosis, but patients with a false-negative CVD diagnosis had ischemic heart disease less frequently. In retrospect, one patient would have been considered a candidate for intravenous thrombolysis (0.2%). Conclusions: Teleneurological consultations are accurate for identifying patients with CVD, and there is a very low rate of missed candidates for thrombolysis. Apart from a lower prevalence of ischemic heart disease, characteristics of “stroke chameleons” were similar to those of correctly identified CVD patients.
Collapse
|
12
|
Stunkel L, Sharma RA, Mackay DD, Wilson B, Van Stavern GP, Newman NJ, Biousse V. Patient Harm Due to Diagnostic Error of Neuro-Ophthalmologic Conditions. Ophthalmology 2021; 128:1356-1362. [PMID: 33713783 DOI: 10.1016/j.ophtha.2021.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To prospectively examine diagnostic error of neuro-ophthalmic conditions and resultant harm at multiple sites. DESIGN Prospective, cross-sectional study. PARTICIPANTS A total of 496 consecutive adult new patients seen at 3 university-based neuro-ophthalmology clinics in the United States in 2019 to 2020. METHODS Collected data regarding demographics, prior care, referral diagnosis, final diagnosis, diagnostic testing, treatment, patient disposition, and impact of the neuro-ophthalmologic encounter. For misdiagnosed patients, we identified the cause of error using the Diagnosis Error Evaluation and Research (DEER) taxonomy tool and whether the patient experienced harm due to the misdiagnosis. MAIN OUTCOME MEASURES The primary outcome was whether patients who were misdiagnosed before neuro-ophthalmology referral experienced harm as a result of the misdiagnosis. Secondary outcomes included appropriateness of referrals, misdiagnosis rate, interventions undergone before referral, and the primary type of diagnostic error. RESULTS Referral diagnosis was incorrect in 49% of cases. A total of 26% of misdiagnosed patients experienced harm, which could have been prevented by earlier referral to neuro-ophthalmology in 97%. Patients experienced inappropriate laboratory testing, diagnostic imaging, or treatment before referral in 23%, with higher rates for patients misdiagnosed before referral (34% of patients vs. 13% with a correct referral diagnosis, P < 0.0001). Seventy-six percent of inappropriate referrals were misdiagnosed, compared with 45% of appropriate referrals (P < 0.0001). The most common reasons for referral were optic neuritis or optic neuropathy (21%), papilledema (18%), diplopia or cranial nerve palsies (16%), and unspecified vision loss (11%). The most common sources of diagnostic error were the physical examination (36%), generation of a complete differential diagnosis (24%), history taking (24%), and use or interpretation of diagnostic testing (13%). In 489 of 496 patients (99%), neuro-ophthalmology consultation (NOC) affected patient care. In 2% of cases, neuro-ophthalmology directly saved the patient's life or vision; in an additional 10%, harmful treatment was avoided or appropriate urgent referral was provided; and in an additional 48%, neuro-ophthalmology provided a diagnosis and direction to the patient's care. CONCLUSIONS Misdiagnosis of neuro-ophthalmic conditions, mismanagement before referral, and preventable harm are common. Early appropriate referral to neuro-ophthalmology may prevent patient harm.
Collapse
Affiliation(s)
- Leanne Stunkel
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | | | - Devin D Mackay
- Departments of Neurology, Ophthalmology, and Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Bradley Wilson
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Nancy J Newman
- Department of Ophthalmology, Emory University, Atlanta, Georgia; Department of Neurology, Emory University, Atlanta, Georgia; Department of Neurological Surgery, Emory University, Atlanta, Georgia
| | - Valérie Biousse
- Department of Ophthalmology, Emory University, Atlanta, Georgia; Department of Neurology, Emory University, Atlanta, Georgia.
| |
Collapse
|
13
|
Frequency, Risk Factors, Causes, and Consequences of Diagnostic Errors in Critically Ill Medical Patients: A Retrospective Cohort Study. Crit Care Med 2020; 47:e902-e910. [PMID: 31524644 DOI: 10.1097/ccm.0000000000003976] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Diagnostic errors are a source of significant morbidity and mortality but understudied in the critically ill. We sought to characterize the frequency, causes, consequences, and risk factors of diagnostic errors among unplanned ICU admissions. DESIGN We conducted a retrospective cohort study of randomly selected nonsurgical ICU admissions between July 2015 and June 2016. SETTING Medical ICU at a tertiary academic medical center. SUBJECTS Critically ill adults with unplanned admission to the medical ICU. MEASUREMENTS AND MAIN RESULTS The primary investigator reviewed patient records using a modified version of the Safer Dx instrument, a validated instrument for detecting diagnostic error. Two intensivists performed secondary reviews of possible errors, and reviewers met periodically to adjudicate errors by consensus. For each confirmed error, we judged harm on a 1-6 rating scale. We also collected detailed demographic and clinical data for each patient. We analyzed 256 unplanned ICU admissions and identified 18 diagnostic errors (7% of admissions). All errors were associated with harm, and only six errors (33%) were recognized by the ICU team within the first 24 hours. More women than men experienced a diagnostic error (11.7% vs 2.7%; p = 0.015, χ test). On multivariable logistic regression analysis, female sex remained independently associated with risk of diagnostic error both at admission (odds ratio, 5.18; 95% CI, 1.34-20.08) and at 24 hours (odds ratio, 11.6; 95% CI, 1.37-98.6). Similarly, Quick Sequential Organ Failure Assessment score greater than or equal to 2 at admission was independently associated with diagnostic error (odds ratio, 5.73; 95% CI, 1.72-19.01). CONCLUSIONS Diagnostic errors may be an underappreciated source of ICU-related harm. Women and higher acuity patients appear to be at increased risk for such errors. Further research is merited to define the scope of error-associated harm and to clarify risk factors for diagnostic errors among the critically ill.
Collapse
|
14
|
Liberman AL, Navi BB, Esenwa CC, Zhang C, Song J, Cheng NT, Labovitz DL, Kamel H, Merkler AE. Misdiagnosis of Cervicocephalic Artery Dissection in the Emergency Department. Stroke 2020; 51:1876-1878. [PMID: 32295512 DOI: 10.1161/strokeaha.120.029390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
Collapse
Affiliation(s)
- Ava L Liberman
- From the Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.L.L., C.C.E., N.T.C., D.L.L.)
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (B.B.N., C.Z., H.K., A.E.M.)
| | - Charles C Esenwa
- From the Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.L.L., C.C.E., N.T.C., D.L.L.)
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (B.B.N., C.Z., H.K., A.E.M.)
| | - Justin Song
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.S.)
| | - Natalie T Cheng
- From the Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.L.L., C.C.E., N.T.C., D.L.L.)
| | - Daniel L Labovitz
- From the Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.L.L., C.C.E., N.T.C., D.L.L.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (B.B.N., C.Z., H.K., A.E.M.)
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY (B.B.N., C.Z., H.K., A.E.M.)
| |
Collapse
|
15
|
Kahraman-Koytak P, Bruce BB, Peragallo JH, Newman NJ, Biousse V. Diagnostic Errors in Initial Misdiagnosis of Optic Nerve Sheath Meningiomas. JAMA Neurol 2020; 76:326-332. [PMID: 30556835 DOI: 10.1001/jamaneurol.2018.3989] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Diagnostic errors can lead to the initial misdiagnosis of optic nerve sheath meningiomas (ONSM), which can lead to vision loss. Objective To identify factors contributing to the initial misdiagnosis of ONSM. Design, Setting, and Participants We retrospectively reviewed 35 of 39 patients with unilateral ONSM (89.7%) who were seen in the tertiary neuro-ophthalmology practice at Emory University School of Medicine between January 2002 and March 2017. The Diagnosis Error Evaluation and Research taxonomy tool was applied to cases with missed/delayed diagnoses. Exposures Evaluation in a neuro-ophthalmology clinic. Main Outcomes and Measures Identifying the cause of diagnostic errors for patients who initially received a misdiagnosis who were found to have ONSM. Results Of 35 patients with unilateral ONSM (30 women [85.7%]; mean [SD] age, 45.26 [15.73] years), 25 (71%) had a diagnosis delayed for a mean (SD) of 62.60 (89.26) months. The most common diagnostic error (19 of 25 [76%]) was clinician assessment failure (errors in hypothesis generation and weighing), followed by errors in diagnostic testing (15 of 25 [60%]). The most common initial misdiagnosis was optic neuritis (12 of 25 [48%]), followed by the failure to recognize optic neuropathy in patients with ocular disorders. Five patients who received a misdiagnosis (20%) underwent unnecessary lumbar puncture, 12 patients (48%) unnecessary laboratory tests, and 6 patients (24%) unnecessary steroid treatment. Among the 16 patients who initially received a misdiagnosis that was later correctly diagnosed at our institution, 11 (68.8%) had prior magnetic resonance imaging (MRI) results that were read as healthy; 5 (45.5%) showed ONSM but were misread by a non-neuroradiologist and 6 (54.5%) were performed incorrectly (no orbital sequence or contrast). Sixteen of the 25 patients (64%) had a poor visual outcome. Conclusions and Relevance Biased preestablished diagnoses, inaccurate funduscopic examinations, a failure to order the correct test (MRI brain/orbits with contrast), and a failure to correctly interpret MRI results were the most common sources of diagnostic errors and delayed diagnosis with worse visual outcomes and increased cost (more visits and tests). Easier access to neuro-ophthalmologists, improved diagnostic strategies, and education regarding neuroimaging should help prevent diagnostic errors.
Collapse
Affiliation(s)
| | - Beau B Bruce
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Emory School of Public Health, Atlanta, Georgia
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
16
|
Ray S, Chakravarty K, Kathuria H, Lal V. Errors in the Diagnosis of Stroke-Tales of Common Stroke Mimics and Strokes in Hiding. Ann Indian Acad Neurol 2019; 22:477-481. [PMID: 31736574 PMCID: PMC6839297 DOI: 10.4103/aian.aian_80_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Stroke mimics are some of the common causes of misdiagnosis of stroke, with an attendant surfeit of finances and resources. Aim: We attempt to discuss some of the common neurological conditions mimicking stroke in the emergency. Methods: We reviewed the articles in English discussing stroke mimics in the last 5 years of publication. Purpose of the Review: We discuss the most common causes of stroke mimics encountered in neurological practice. In this short communication, we shall focus on the discussion of the diagnostic pitfalls and clinical clues that will help distinguish mimics from a true stroke.
Collapse
Affiliation(s)
- Sucharita Ray
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Heena Kathuria
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
17
|
Dubosh NM, Edlow JA, Goto T, Camargo CA, Hasegawa K. Missed Serious Neurologic Conditions in Emergency Department Patients Discharged With Nonspecific Diagnoses of Headache or Back Pain. Ann Emerg Med 2019; 74:549-561. [DOI: 10.1016/j.annemergmed.2019.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/08/2018] [Accepted: 01/04/2019] [Indexed: 12/30/2022]
|
18
|
Shen JZ, Memon AA, Lin C. Advice From Prior Fellows to Current Fellows on Preparation for Transition to Junior Attending. Stroke 2019; 50:e250-e252. [DOI: 10.1161/strokeaha.119.024897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey Z. Shen
- From the Department of Neurology, University of Alabama, Birmingham
| | - Adeel A. Memon
- From the Department of Neurology, University of Alabama, Birmingham
| | - Chen Lin
- From the Department of Neurology, University of Alabama, Birmingham
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW This review summarizes the recent literature on diagnostic error relevant to the practice of neuro-ophthalmology, and evaluates the potential for increased access to neuro-ophthalmology to decrease rates of diagnostic error, thereby reducing medical harm and spending on unnecessary tests and treatments. RECENT FINDINGS Despite medical advances, current research continues to show alarmingly high rates of diagnostic error. Research into diagnostic error shows that many of these errors can be traced to cognitive errors. Recent studies on diagnostic problems relevant to neuro-ophthalmology, including studies of misdiagnosis of posterior communicating artery aneurysms, idiopathic intracranial hypertension, optic neuritis, and optic nerve sheath meningiomas, have identified major causes of diagnostic error in these conditions. SUMMARY Studies on diagnostic error in neuro-ophthalmologic conditions show that prior to evaluation by a neuro-ophthalmologist, patients may undergo unnecessary tests and treatments that are costly and potentially harmful. Further research on diagnostic error will inform better utilization of neuro-ophthalmologists as a resource to decrease diagnostic error.
Collapse
|
20
|
Dorňák T, Justanová M, Konvalinková R, Říha M, Mužík J, Hoskovcová M, Srp M, Navrátilová D, Otruba P, Gál O, Svobodová I, Dušek L, Bareš M, Kaňovský P, Jech R. Prevalence and evolution of spasticity in patients suffering from first‐ever stroke with carotid origin: a prospective, longitudinal study. Eur J Neurol 2019; 26:880-886. [DOI: 10.1111/ene.13902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- T. Dorňák
- Faculty of Medicine Department of Neurology Palacky University and University Hospital OlomoucCzech Republic
| | - M. Justanová
- Faculty of Medicine Department of Neurology Masaryk University and St. Anne's Teaching Hospital BrnoCzech Republic
| | - R. Konvalinková
- First Faculty of Medicine Department of Neurology and Center of Clinical Neuroscience Charles University in Prague PragueCzech Republic
| | - M. Říha
- Department of Rehabilitation Medicine Central Military Hospital PragueCzech Republic
| | - J. Mužík
- Faculty of Medicine Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic
| | - M. Hoskovcová
- First Faculty of Medicine Department of Neurology and Center of Clinical Neuroscience Charles University in Prague PragueCzech Republic
| | - M. Srp
- First Faculty of Medicine Department of Neurology and Center of Clinical Neuroscience Charles University in Prague PragueCzech Republic
| | - D. Navrátilová
- Faculty of Medicine Department of Neurology Palacky University and University Hospital OlomoucCzech Republic
| | - P. Otruba
- Faculty of Medicine Department of Neurology Palacky University and University Hospital OlomoucCzech Republic
| | - O. Gál
- First Faculty of Medicine Department of Neurology and Center of Clinical Neuroscience Charles University in Prague PragueCzech Republic
| | - I. Svobodová
- Faculty of Medicine Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic
| | - L. Dušek
- Faculty of Medicine Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic
| | - M. Bareš
- Faculty of Medicine Department of Neurology Masaryk University and St. Anne's Teaching Hospital BrnoCzech Republic
- Department of Neurology School of Medicine University of Minnesota Minneapolis MN USA
| | - P. Kaňovský
- Faculty of Medicine Department of Neurology Palacky University and University Hospital OlomoucCzech Republic
| | - R. Jech
- First Faculty of Medicine Department of Neurology and Center of Clinical Neuroscience Charles University in Prague PragueCzech Republic
| |
Collapse
|