Diagnostic accuracy of neurological problems in the emergency department.
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.
Moeller
Jeremy J
JJ
Division of Neurology, Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Kurniawan
Joelius
J
Gubitz
Gordon J
GJ
Ross
John A
JA
Bhan
Virender
V
D000368:Aged; D000704:Analysis of Variance; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis*; D009422:Nervous System Diseases / Q000175:diagnosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012640:Seizures / Q000175:diagnosis; D020521:Stroke / Q000175:diagnosis; D013575:Syncope / Q000175:diagnosis*; D014717:Vertigo / Q000175:diagnosis*