Stroke hospitalization after misdiagnosis of "benign dizziness" is lower in specialty care than general practice: A population-based cohort analysis of missed stroke using SPADE methods

Tzu Pu Chang, Anand K. Bery, Zheyu Wang, Krisztian Sebestyen, Yu Hung Ko, Ava L. Liberman, David E. Newman-Toker

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)96-106
Number of pages11
JournalDiagnosis
Volume9
Issue number1
DOIs
StatePublished - Feb 1 2022

Keywords

  • ambulatory care
  • diagnostic error
  • dizziness
  • health services research
  • stroke

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint

Dive into the research topics of 'Stroke hospitalization after misdiagnosis of "benign dizziness" is lower in specialty care than general practice: A population-based cohort analysis of missed stroke using SPADE methods'. Together they form a unique fingerprint.

Cite this