When We Miss Strokes, We Aren't Missing Much
Luckily, very little disability results from subtle clinical presentations.
Much ado is made about diagnostic error in the emergency department, including such outlandish claims that hundreds of thousands of people are injured by our malfeasance. Even more, that same report takes a Special Focus on stroke, going even further into the realm of fantasy regarding the harms of under-appreciated dizziness.
The face validity of these claims notwithstanding, we now see a lovely report looking at 1) are we really missing that many strokes, and 2) how much harm is being suffered as a result?
The answers are: 1) no, 2) even less.
Depending on the inclusion criteria of this retrospective study, the rate of representation for missed stroke is a fraction of a fraction of a percent within the reasonably attributable time frames. Then, fortunately, less than half of those missed stroke patients suffered serious morbidity as a result.
Much ado is made out of the scope of diagnostic errors and their potential downstream harms, but not all errors result in the same magnitude of harm. In this instance, it is reasonable to suggest most missed opportunities for diagnosis of stroke likely occur because the symptoms are minor and non-disabling.