Risk of missed stroke higher in postpartum than nonmaternal populations
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The proportion of missed stroke diagnoses was more than four times higher in postpartum women with acute stroke compared with rates reported in nonmaternal populations, according to research presented at International Stroke Conference.
“Stroke is a leading cause of maternal morbidity and mortality, and diagnostic delays can occur,” Eliza C. Miller, MD, MS, assistant professor of neurology at Columbia University Irving Medical Center, and colleagues wrote. “Prior work in nonmaternal populations showed that 9% of strokes are missed at initial [emergency department] presentation.”
Researchers sought to test the hypothesis that a higher proportion of pregnant or postpartum women with acute stroke would have a pre-stroke medical visit in which the opportunity to diagnosis cerebrovascular events was missed, likely because of their younger age and lower risk profile.
Miller and colleagues used an institutional stroke registry to retrospectively identify 634 female patients, aged 18 to 50 years, who were admitted to an urban academic stroke center between January 2012 and December 2021. All participants had a confirmed diagnosis of ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) or cerebral venous thrombosis.
Researchers evaluated medical encounters within 1 month of stroke via the Safer Stroke-Dx instrument, a validated chart review tool used to detect encounters with a missed opportunity for stroke diagnosis. They categorized encounters as false negative stroke (FNS) or no FNS (for patients with insufficient data).
Of 55 postpartum stroke participants (9%), the proportion with FNS was 44% (95% CI, 30-57), and among those with SAH or ICH (n = 31), the proportion of FNS was 52% (95% CI, 39-65).
Additionally, postpartum patients with FNS had more pre-stroke medical encounters than those without FNS (mean number of encounters, 2.5 vs 1.4).
“Among postpartum patients with acute stroke, the majority of which were hemorrhagic, the proportion of missed stroke diagnosis was [more than four times] higher than previously published rates in the nonmaternal population,” Miller and colleagues wrote. “Tailored stroke screening tools are needed to avoid diagnostic errors in this patient population.”