Abstract
Objectives
The misdiagnosis of acute ischemic stroke in young adults is a significant problem
since patients may have many decades of potential disability. Also, proven therapies
for acute stroke may not be administered if there is an initial misdiagnosis. We assessed
the hypothesis that early use of MRI, arrival by ambulance, and presentation to a
Primary Stroke Center (PSC) would be associated with a reduced rate of misdiagnosis.
Methods
A prospective database of young adults (ages 16–49 years) with ischemic stroke (final diagnosis provided by vascular neurologists) was
reviewed. We collected information on several variables, including age, race, arrival
by ambulance, whether brain MRI was performed within 48 h, and initial presentation to a PSC. Variables were tested against emergency department
(ED) misdiagnosis using univariate and multivariate methods.
Results
77 patients with a mean age of 37.9 years were reviewed. 48.3% of patients arrived by ambulance, 53.2% had a brain MRI
within 48 h, and 23.4% initially presented to a PSC. The overall rate of ED misdiagnosis was
14.5%. In multivariate testing, performance of MRI within 48 h (p=0.023) was associated with a lower rate of misdiagnosis and age <35 years was linked with greater likelihood of misdiagnosis (p=0.047).
Conclusions
Early performance of MRI leads to greater accuracy of stroke diagnosis in young adults
presenting to the ED. Patients less than age 35 years have a greater risk of misdiagnosis. ED physicians and neurologists should consider
early use of MRI in young adults with stroke-like deficits and diagnostic uncertainty.
Keywords
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Article info
Publication history
Published online: November 15, 2012
Accepted:
October 3,
2012
Received in revised form:
September 25,
2012
Received:
March 3,
2012
Identification
Copyright
© 2012 Published by Elsevier Inc.
