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ER Less Likely to Diagnose Stroke in Younger Folks
Date:2/18/2009

New research finds misdiagnosis risk goes up as age goes down

WEDNESDAY, Feb. 18 (HealthDay News) -- An 18-year-old boy complaining of numbness at a Detroit emergency room was discharged after health-care professionals determined he was drunk.

A 24-year-old woman with sharp pain in her left eye and loss of feeling in her right arm was told by ER doctors that she had a migraine.

And a 29-year-old man with slurred speech, a facial droop and vertigo was diagnosed with peripheral vertigo during his emergency room visit.

In fact, each one of these younger adults had had a stroke, which went undetected because of their age, according to new research to be presented Wednesday at the American Stroke Association's International Stroke Conference in San Diego.

The research, looking at ER visits by people under 50, found that the risk of misdiagnosis of a stroke increases as patient age goes down.

"Emergency room personnel need to have a heightened sensitivity to the possibility of stroke in people . . . under 45," said senior study author Dr. Seemant Chaturvedi, director of the stroke program at Wayne State University in Detroit. "There needs to be a solid familiarity with the combination of symptoms that would indicate stroke rather than something more benign."

"Identifying what we consider to be an 'old person's disease' in young people is always a challenge because there's denial on the part of patients and denial on the part of caregivers," added Dr. Robert Greenberg, an assistant professor of emergency medicine at Texas A&M Health Science Center College of Medicine and vice chair of emergency medicine with Scott & White in Temple. "Everybody should be given a stroke assessment. If you see someone who comes in with dizziness and trouble walking, it should cross your mind."

Stroke is the third leading cause of death in the United States. Failure to identify and treat a stroke quickly can lead to severe disability, and even loss of life.

The study authors looked at 57 people under the age of 50 who went to a Detroit emergency room with various symptoms. The participants were equally divided in gender, and their median age was 34.

All but one of the patients had had a stroke. But eight patients, or 14 percent of the total, were misdiagnosed by hospital staff.

"Those under the age of 35 were misdiagnosed one-third of the time," Chaturvedi added. And strokes occurring in the back of the brain were more often misdiagnosed, possibly because symptoms were varied.

But such mistakes may be all too easy to make, Greenberg pointed out.

"These [cases] are all unusual, because you don't [often] see stroke in young patients," he said. "The truth is, distinguishing symptoms such as vertigo or inner ear disorders and [stroke] is pretty difficult for anybody."

"One premise in medicine and society that we all ignore a lot is that age doesn't protect you from illness," Greenberg added. "Anybody of any age can get just about anything, [but] the likelihood of this occurring in a young person is way less. The challenge is to be able to identify atypical presentations of a common disease or common presentations of an unusual disease."

A second study to be presented at the conference found that pharmacies don't regularly recommend that callers with stroke symptoms call 9-1-1.

For their findings, researchers at West Virginia University in Morgantown surveyed 71 pharmacies and found that only one out of every five people who answered the store's phones recommended that potential stroke victims call emergency medical services.

Stroke patients who get to the hospital via EMS get there faster and are more likely to get clot-busting treatment, the study authors pointed out.

Stroke experts say that people of all ages should rush to the hospital if they have any of these symptoms: numbness or weakness of the face, arm or leg, particularly if it only occurs on one side of the body; confusion and trouble speaking; problems with vision; dizziness or loss of balance, or sudden headache.

More information

The American Heart Association has more on stroke warning signs.



SOURCES: Seemant Chaturvedi, M.D., professor, neurology, and director, stroke program, Wayne State University, Detroit; Robert Greenberg, M.D., assistant professor, emergency medicine, Texas A&M Health Science Center College of Medicine, and vice chair, emergency medicine, Scott & White, Temple; Feb. 18, 2009, presentation, International Stroke Conference, San Diego


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