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Diagnostic Accuracy of Neurological Problems in the Emergency Department

Published online by Cambridge University Press:  02 December 2014

Jeremy J Moeller ,
Joelius Kurniawan ,
Gordon J Gubitz ,
John A Ross  and
Virender Bhan
Jeremy J Moeller
Affiliation:
Division of Neurology, Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
Joelius Kurniawan
Affiliation:
Division of Neurology, Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
Gordon J Gubitz
Affiliation:
Division of Neurology, Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
John A Ross
Affiliation:
Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
Virender Bhan
Affiliation:
Division of Neurology, Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract

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Background:

Previous studies describe significant rates of misdiagnosis of stroke, seizure and other neurological problems, but there are few studies examining diagnostic accuracy of all emergency referrals to a neurology service. This information could be useful in focusing the neurological education of physicians who assess and refer patients with neurological complaints in emergency departments.

Methods:

All neurological consultations in the emergency department at a tertiary-care teaching hospital were recorded for six months. The initial diagnosis of the requesting physician was recorded for each patient. This was compared to the initial diagnosis of the consulting neurologist and to the final diagnosis, as determined by retrospective chart review.

Results:

Over a six-month period, 493 neurological consultations were requested. The initial diagnosis of the requesting physician agreed with the final diagnosis in 60.4% (298/493) of cases, and disagreed or was uncertain in 35.7% of cases (19.1% and 16.6% respectively). In 3.9% of cases, the initial diagnosis of both the referring physician and the neurologist disagreed with the final diagnosis. Common misdiagnoses included neurocardiogenic syncope, peripheral vertigo, primary headache and psychogenic syndromes. Often, these were initially diagnosed as stroke or seizure.

Conclusions:

Our data indicate that misdiagnosis or diagnostic uncertainty occurred in over one-third of all neurological consultations in the emergency department setting. Benign neurological conditions, such as migraine, syncope and peripheral vertigo are frequently mislabeled as seizure or stroke. Educational strategies that emphasize emergent evaluation of these common conditions could improve diagnostic accuracy, and may result in better patient care.

Résumé:

<span class='bold'>RÉSUMÉ:</span><span class='bold'><span class='italic'>Contexte:</span></span>

Certaines études font état d’un taux significatif de diagnostics erronés d’accidents cérébrovasculaires, de crises convulsives et d’autres problèmes neurologiques, mais peu d’études ont examiné l’exactitude diagnostique de tous les cas référés d’urgence à un service de neurologie. Cette information serait utile pour cibler l’éducation neurologique des médecins qui évaluent et qui réfèrent les patients qui consultent à la salle d’urgence pour des troubles neurologiques.

<span class='bold'><span class='italic'>Méthodes:</span></span>

Toutes les consultations neurologiques à la salle d’urgence d’un höpital d’enseignement de soins tertiaires ont été relevées sur une période de six mois. Le diagnostic initial du médecin référant a été noté pour chaque patient. Une revue rétrospective de dossiers a permis de comparer ce diagnostic au diagnostic initial du neurologue consultant et au diagnostic final.

<span class='bold'><span class='italic'>Résultats:</span></span>

Au cours d’une période de six mois, 493 consultations ont été demandées en neurologie. Le diagnostic initial du médecin référant était concordant avec le diagnostic final chez 60,4% des cas (298/493) et discordant ou incertain chez 35,7% des cas (19,1% et 16,6% respectivement). Chez 3,9% des cas, le diagnostic initial du médecin référant et du neurologue ne concordaient pas avec le diagnostic final. Les diagnostics erronés les plus fréquents étaient la syncope neurocardiogénique, le vertige d’origine périphérique, la céphalée primaire et les syndromes psychogéniques. Souvent ces cas recevaient un diagnostic initial d’un accident cérébrovasculaire ou de crise convulsive.

<span class='bold'><span class='italic'>Conclusions:</span></span>

Nos données révèlent qu’un diagnostic erroné ou incertain a été posé chez plus du tiers des patients vus à la salle d’urgence qui sont référés en neurologie. Des affections neurologiques bénignes comme la migraine, la syncope et le vertige d’origine périphérique sont fréquemment diagnostiqués comme une crise convulsive ou un accident cérébrovasculaire. Des stratégies d’éducation qui mettent l’emphase sur l’évaluation de ces affections fréquentes à la salle d’urgence pourraient améliorer l’exactitude diagnostique ainsi que les soins prodigués aux patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 3 , July 2008 , pp. 335 - 341
Copyright
Copyright © The Canadian Journal of Neurological 2008

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