TY - JOUR
T1 - Stroke hospitalization after misdiagnosis of "benign dizziness" is lower in specialty care than general practice
T2 - A population-based cohort analysis of missed stroke using SPADE methods
AU - Chang, Tzu Pu
AU - Bery, Anand K.
AU - Wang, Zheyu
AU - Sebestyen, Krisztian
AU - Ko, Yu Hung
AU - Liberman, Ava L.
AU - Newman-Toker, David E.
N1 - Publisher Copyright:
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Objectives: Isolated dizziness is a challenging stroke presentation in the emergency department, but little is known about this problem in other clinical settings. We sought to compare stroke hospitalizations after treat-And-release clinic visits for purportedly "benign dizziness"between general and specialty care settings. Methods: This was a population-based retrospective cohort study from a national database. We included clinic patients with a first incident treat-And-release visit diagnosis of non-specific dizziness/vertigo or a peripheral vestibular disorder (ICD-9-CM 780.4 or 386.x [not 386.2]). We compared general care (internal medicine, family medicine) vs. specialty care (neurology, otolaryngology) providers. We used propensity scores to control for baseline stroke risk differences unrelated to dizziness diagnosis. We measured excess (observed>expected) stroke hospitalizations in the first 30 d (i.e., missed strokes associated with an adverse event). Results: We analyzed 144,355 patients discharged with "benign dizziness"(n=117,117 diagnosed in general care; n=27,238 in specialty care). After propensity score matching, patients in both groups were at higher risk of stroke in the first 30 d (rate difference per 10,000 treat-And-release visits for "benign dizziness"24.9 [95% CI 18.6-31.2] in general care and 10.6 [95% CI 6.3-14.9] in specialty care). Short-Term stroke risk was higher in general care than specialty care (relative risk, RR 2.2, 95% CI 1.5-3.2) while the long-Term risk was not significantly different (RR 1.3, 95% CI 0.9-1.9), indicating higher misdiagnosis-related harms among dizzy patients who initially presented to generalists after adequate propensity matching. Conclusions: Missed stroke-related harms in general care were roughly twice that in specialty care. Solutions are needed to address this care gap.
AB - Objectives: Isolated dizziness is a challenging stroke presentation in the emergency department, but little is known about this problem in other clinical settings. We sought to compare stroke hospitalizations after treat-And-release clinic visits for purportedly "benign dizziness"between general and specialty care settings. Methods: This was a population-based retrospective cohort study from a national database. We included clinic patients with a first incident treat-And-release visit diagnosis of non-specific dizziness/vertigo or a peripheral vestibular disorder (ICD-9-CM 780.4 or 386.x [not 386.2]). We compared general care (internal medicine, family medicine) vs. specialty care (neurology, otolaryngology) providers. We used propensity scores to control for baseline stroke risk differences unrelated to dizziness diagnosis. We measured excess (observed>expected) stroke hospitalizations in the first 30 d (i.e., missed strokes associated with an adverse event). Results: We analyzed 144,355 patients discharged with "benign dizziness"(n=117,117 diagnosed in general care; n=27,238 in specialty care). After propensity score matching, patients in both groups were at higher risk of stroke in the first 30 d (rate difference per 10,000 treat-And-release visits for "benign dizziness"24.9 [95% CI 18.6-31.2] in general care and 10.6 [95% CI 6.3-14.9] in specialty care). Short-Term stroke risk was higher in general care than specialty care (relative risk, RR 2.2, 95% CI 1.5-3.2) while the long-Term risk was not significantly different (RR 1.3, 95% CI 0.9-1.9), indicating higher misdiagnosis-related harms among dizzy patients who initially presented to generalists after adequate propensity matching. Conclusions: Missed stroke-related harms in general care were roughly twice that in specialty care. Solutions are needed to address this care gap.
KW - ambulatory care
KW - diagnostic error
KW - dizziness
KW - health services research
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85124999897&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124999897&partnerID=8YFLogxK
U2 - 10.1515/dx-2020-0124
DO - 10.1515/dx-2020-0124
M3 - Article
C2 - 34147048
AN - SCOPUS:85124999897
SN - 2194-8011
VL - 9
SP - 96
EP - 106
JO - Diagnosis
JF - Diagnosis
IS - 1
ER -