Abstract TP273: Misdiagnosis of Pregnancy-Associated Stroke in the Emergency Department

Abstract

Introduction: Pregnancy and the postpartum period are associated with an increased risk of ischemic and hemorrhagic strokes. The incidence of missed or delayed diagnosis of pregnancy-associated stroke in the emergency setting is unknown. Methods: We conducted a retrospective cohort study of all women aged 12 years or older who were hospitalized for labor and delivery using deidentified administrative claims data from all nonfederal EDs and hospitals in New York from 2006-2016 and Florida from 2005-2018. In this cohort, we then identified women hospitalized for a cerebrovascular event (either ischemic or hemorrhagic stroke) using previously validated ICD-9-CM or ICD-10-CM codes during a 270-day period extending from 6 months before through 3 months after delivery. We defined probable ED misdiagnosis of stroke as having an ED treat-and-release visit for neurological complains (e.g., headache, dizziness, numbness) within the 14 days preceding their stroke hospitalization. Logistic regression was used to compare rates of clinical outcomes in pregnant or postpartum stroke patients with and without probable stroke misdiagnosis after adjusting for demographic and vascular risk factors. Results: Among 3,474,960 women hospitalized for labor and delivery, 350 (0.01%) were hospitalized for an ischemic or hemorrhagic stroke during the study period. Out of the 350 pregnant or postpartum women hospitalized for stroke, 17 (4.9%; median age 30) had at least one preceding ED visit for a neurological symptom (probable misdiagnosis). There was no difference in length of stay (4 versus 5 days, p = 0.97), mortality (0% versus 3.6%, p = 1.00), and discharge to home (70.6% versus 57.1%, p = 0.27) after stroke hospitalization between patients with versus without a probable ED misdiagnosis. Conclusion: Probable ED misdiagnosis occurred in nearly 1 of 20 cases of pregnancy-associated stroke in a large, multistate cohort. However, misdiagnosis was not associated with increased length of stay, higher mortality, or lower rates of discharge to home after stroke.