Stroke Mimics and Accuracy of Referrals Made by Emergency Department Doctors in Japan for Patients with Suspected Stroke

Abstract

Background: Stroke mimics (SMs)are medical conditions that are at first considered to be of cerebrovascular etiology but turn out to be a condition other than stroke. While many reports on SMs have been published, there have been none from Japan. Thus, we sought to assess the current state of SMs in a Japanese population. Methods: We collected data of patients referred with suspicion of stroke to neurosurgeons by emergency department (ED) doctors, and we retrospectively evaluated the diagnosis concordance rate between the ED doctors and the neurosurgeons. We also assessed the plausible causes leading to misdiagnosis of stroke. Results: Of the 226 consecutive referrals with suspicion of stroke, only 71.7% were accurate. Furthermore, 75% of the SMs were disorders unrelated to neurosurgery, such as psychiatric disorders, peripheral dizziness/vertigo, and cardiovascular events. In other words, referring those patients to neurosurgeons was inappropriate. We found that perceived notion or premature assumption of stroke accounted for 43.8% of the stroke mimic patients and was the most important reason for the misdiagnosis. Conclusions: This is the first report on SMs in a Japanese population. About one-third of all referrals with suspicion of stroke made by ED doctors were inappropriate. Including more information on stroke diagnosis in the educational program for young doctors in Japan would be beneficial for improving the quality of the initial medical examination of patients with suspected stroke.