The Misdiagnosis of Cerebrovascular Disease in Emergent Headache Evaluations

急诊头痛评估中脑血管疾病的误诊

基本信息

批准号：
10447117
负责人：
Ava L Liberman
金额：
$ 19.66万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10447117
关键词：
Accident and Emergency department Acute Address Admission activity Age American Arteries Back Pain Bedside Testings Benign Brain Stem Case-Control Studies Cerebral hemisphere hemorrhage Cerebrovascular Disorders Cervical Cessation of life Clinical Cohort Studies Consult Data Data Sources Decision Making Detection Development Diagnosis Diagnostic Diagnostic Errors Disease Dissection Education Educational Intervention Electronic Health Record Emergency Department patient Emergency Situation Emergency department visit Evaluation Event Failure Frequencies Future Goals Headache Health Health system High Prevalence Hospitalization Hospitals Incidence Individual Institution Intervention Interview Ischemia Ischemic Stroke Knowledge Life Measures Medical Medical center Medicine Methods Minor Minority Modeling Morbidity - disease rate Neurologic Neurologic Examination Neurologic Signs Neurologist Observational Study Outcome Patient observation Patient-Focused Outcomes Patients Pattern Physicians Process Provider Race Reporting Research Savings Screening procedure Sentinel Source Stroke Subarachnoid Hemorrhage Symptoms Syndrome Thrombosis Thunderclap Headaches Time Transient Ischemic Attack Vascular Headaches Vertigo Visit Work accurate diagnosis base billing data cerebral vein cerebrovascular clinical decision support cohort constriction design diagnostic accuracy diagnostic platform disability emergency settings evidence base experience follow-up improved indexing insight intervention cost mortality neuroimaging novel programs prospective provider factors stroke patient tool

项目摘要

Nearly every American will experience a diagnostic error in his or her lifetime. Diagnostic errors are particularly damaging when treatable diseases associated with significant morbidity and mortality are missed. Misdiagnosis of cerebrovascular events in the emergency setting can result in lost or delayed opportunities for life-saving treatments. Up to 9% of the estimated 700,000 strokes seen annually in the US are initially misdiagnosed in emergency departments. Among stroke patients who are misdiagnosed, headache is one of the most common presenting symptoms. Though vascular headaches are common among stroke patients, the clear majority of headaches evaluated in US emergency departments are benign. There are few evidence based clinical decision rules to detect acute cerebrovascular disease among patients who complain of headache, particularly for those with non-thunderclap semiology. We therefore propose to quantify the rate of probable misdiagnosis of cerebrovascular disease among headache patients using a large regional information exchange that contains data from multiple institutions based on rates of short-term stroke admission after discharge with a new primary headache diagnosis. We will use information from the Emergency Department of John Hopkins Health System to identify patient and physician-level factors associated with cerebrovascular disease misdiagnosis. Based on prior research, we anticipate that misdiagnosis will be associated with young age and minority race as well as flawed physician clinical reasoning and knowledge gaps in headache medicine. To identify additional sources of diagnostic error, we will conduct a mixed-methods prospective observational study of headache patients evaluated in the Montefiore Medical Center Emergency Department. This work will be augmented by physician interviews at the same center designed to characterize shortcomings in emergency system diagnostic processes. This multi-pronged research approach uses different data sources to address a novel topic that is sure to provide needed insight as to how to improve the diagnosis and treatment of cerebrovascular diseases. We hope this work will pave the way for the development of targeted screening tools, educational interventions, bedside testing, or other low-cost interventions to reduce patient morbidity and mortality by improving diagnostic accuracy. Additionally, our methods of determining rates of cerebrovascular misdiagnosis among headache patients may serve as a model for future symptom-specific studies of diagnostic error in cerebrovascular disease.

几乎每个美国人都会在他或她的一生中遇到诊断错误。当错过与明显的发病率和死亡率相关的可治疗疾病时，诊断错误尤其有害。在紧急情况下对脑血管事件的误诊可能导致挽救生命治疗的机会丢失或延迟。最初在急诊部门误诊在美国每年看到的700,000杆中，多达9％。在被误诊的中风患者中，头痛是最常见的症状之一。尽管血管头痛在中风患者中很常见，但在美国急诊室评估的明显头痛是良性的。在抱怨头痛的患者中，很少有基于证据的临床决策规则可以检测到急性脑血管疾病，尤其是对于那些非thunderclap符合性的患者。因此，我们建议使用大量的区域信息交换来量化头痛患者对脑血管疾病的可能误诊的率，该信息通过新的原发性头痛诊断后的短期中风入院率，其中包含来自多个机构的数据。我们将使用约翰·霍普金斯卫生系统急诊室的信息来识别与脑血管疾病误诊有关的患者和医师级别的因素。基于先前的研究，我们预计误诊将与年轻年龄和少数群体以及头痛医学中有缺陷的医师临床推理和知识差距有关。为了确定诊断错误的其他来源，我们将对在蒙特菲奥尔医疗中心急诊室评估的头痛患者进行混合方法。该工作将通过同一中心的医师访谈来增强这项工作，旨在表征紧急系统诊断过程中的缺点。这种多管齐下的研究方法使用不同的数据源来解决一个新的主题，该主题一定会提供有关如何改善脑血管疾病的诊断和治疗所需的见解。我们希望这项工作将为开发目标筛查工具，教育干预措施，床头测试或其他低成本干预措施铺平道路，以通过提高诊断准确性来降低患者的发病率和死亡率。此外，我们确定头痛患者脑血管误诊率的方法可能是对脑血管疾病诊断错误的未来症状特异性研究的模型。

项目成果

期刊论文数量（25）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.

使用故障模式、影响和关键性分析对急性中风诊断过程进行风险评估。

DOI：
10.1111/acem.14648
发表时间：
2023
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
0
作者：
Liberman,AvaL;Holl,JaneL;Romo,Elida;Maas,Matthew;Song,Sarah;Prabhakaran,Shyam
通讯作者：
Prabhakaran,Shyam

Cerebrovascular disease hospitalizations following emergency department headache visits: A nested case-control study.

DOI：
10.1111/acem.14353
发表时间：
2022-01
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
0
作者：
Liberman AL;Hassoon A;Fanai M;Badihian S;Rupani H;Peterson SM;Sebestyen K;Wang Z;Zhu Y;Lipton RB;Newman-Toker DE
通讯作者：
Newman-Toker DE

Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes.

DOI：
10.1038/s41598-020-79499-1
发表时间：
2021-01-11
期刊：
Scientific reports
影响因子：
4.6
作者：
Dardick JM;Flomenbaum D;Labovitz DL;Cheng N;Liberman AL;Esenwa C
通讯作者：
Esenwa C

Early ischaemic and haemorrhagic complications after atrial fibrillation-related ischaemic stroke: analysis of the IAC study.

DOI：
10.1136/jnnp-2020-323041
发表时间：
2020-07
期刊：
Journal of neurology, neurosurgery, and psychiatry
影响因子：
0
作者：
Yaghi S;Henninger N;Scher E;Giles J;Liu A;Nagy M;Kaushal A;Azher I;Mac Grory B;Fakhri H;Espaillat KB;Asad SD;Pasupuleti H;Martin H;Tan J;Veerasamy M;Liberman AL;Esenwa C;Cheng N;Moncrieffe K;Moeini-Naghani I;Siddu M;Trivedi T;Leon Guerrero CR;Khan M;Nouh A;Mistry E;Keyrouz S;Furie K
通讯作者：
Furie K

Factors associated with hospitalization for ischemic stroke and TIA following an emergency department headache visit.