Acad Emerg Med. 2021 Jul 26. doi: 10.1111/acem.14353. Online ahead of print.
ABSTRACT
BACKGROUND: Delayed diagnosis of cerebrovascular disease (CVD) among patients can result in substantial harm. If diagnostic process failures can be identified at Emergency Department (ED) visits that precede CVD hospitalization, interventions to improve diagnostic accuracy can be developed.
METHODS: We conducted a nested case-control study using a cohort of adult ED patients discharged from a single medical center with a benign headache diagnosis from 10/1/2015-3/31/2018. Hospitalizations for CVD within 1 year of index ED visit were identified using a regional health information exchange. Patients with subsequent CVD hospitalization (cases) were individually matched to patients without subsequent hospitalization (controls) using patient’s age and visit date. Demographic, clinical, and ED processes characteristics were assessed via detailed chart review. McNemar’s test for categorical and paired t-test for continuous variables were used with statistical significance set at ≤0.05.
RESULTS: Of the 9,157 patients with ED headache visits, 57 (0.6%; 95% CI:0.5-0.8) had a subsequent CVD hospitalization. Median time from ED visit to hospitalization was 107 days. In twenty-five patients (43.9%; 25/57) the CVD hospitalization and the index ED visit were at different hospitals. Fifty-three cases and 53 matched controls were included in the final study analysis. Cases and controls had similar baseline demographic and headache characteristics. Cases more often had a history of stroke (32.1% vs. 13.2%, p=0.02) and neurosurgery (13.2% vs. 1.9%, p=0.03) prior to the index ED visit. Cases more often had <2 components of the neurological exam documented (30.2% vs. 11.3%, p=0.03).
CONCLUSION: We found that 0.6% of patients with an ED headache visit had subsequent CVD hospitalization, often at another medical center. ED visits for headache complaints among patients with prior stroke or neurosurgical procedures may be important opportunities for CVD prevention. Documented neurological examinations were poorer among cases, which may represent an opportunity for ED process improvement.
PMID:34309135 | DOI:10.1111/acem.14353
