TY - JOUR
T1 - Cerebrovascular disease hospitalizations following emergency department headache visits
T2 - A nested case–control study
AU - Liberman, Ava L.
AU - Hassoon, Ahmed
AU - Fanai, Mehdi
AU - Badihian, Shervin
AU - Rupani, Hetal
AU - Peterson, Susan M.
AU - Sebestyen, Krisztian
AU - Wang, Zheyu
AU - Zhu, Yuxin
AU - Lipton, Richard B.
AU - Newman-Toker, David E.
N1 - Publisher Copyright:
© 2021 by the Society for Academic Emergency Medicine
PY - 2022/1
Y1 - 2022/1
N2 - 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 October 1, 2015 to March 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 age and visit date. Demographic, clinical, and ED process 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 9157 patients with ED headache visits, 57 (0.6%, 95% confidence interval [CI] = 0.5–0.8) had a subsequent CVD hospitalization. Median time from ED visit to hospitalization was 107 days. In 25 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 less than two components of the neurologic examination 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 neurologic examinations were poorer among cases, which may represent an opportunity for ED process improvement.
AB - 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 October 1, 2015 to March 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 age and visit date. Demographic, clinical, and ED process 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 9157 patients with ED headache visits, 57 (0.6%, 95% confidence interval [CI] = 0.5–0.8) had a subsequent CVD hospitalization. Median time from ED visit to hospitalization was 107 days. In 25 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 less than two components of the neurologic examination 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 neurologic examinations were poorer among cases, which may represent an opportunity for ED process improvement.
UR - http://www.scopus.com/inward/record.url?scp=85112777108&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112777108&partnerID=8YFLogxK
U2 - 10.1111/acem.14353
DO - 10.1111/acem.14353
M3 - Article
C2 - 34309135
AN - SCOPUS:85112777108
SN - 1069-6563
VL - 29
SP - 41
EP - 50
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 1
ER -