Omran Setareh Salehi, Zhang Cenai, Seitz Alison, Bruce Samuel S, Liao Vanessa, Pawar Anokhi, Navi Babak B, Kamel Hooman, Liberman Ava L
University of Colorado, Department of Neurology, Aurora, CO, USA.
Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
J Stroke Cerebrovasc Dis. 2025 Jan;34(1):108139. doi: 10.1016/j.jstrokecerebrovasdis.2024.108139. Epub 2024 Nov 27.
Pregnancy and the postpartum period are associated with an increased risk of ischemic and hemorrhagic stroke. The incidence of missed or delayed diagnosis of pregnancy-associated stroke (PAS) in the emergency setting is unknown.
We conducted a retrospective cohort study of women hospitalized for labor and delivery identified through administrative claims data from all nonfederal EDs and hospitals in 11 states (New York 2006-2017, Florida 2005-2019, 3 states from 2016-2020, 6 states from 2016-2019). We then identified women hospitalized for stroke (ischemic or hemorrhagic) using validated ICD-9-CM or ICD-10-CM codes during a 270-day period extending from 6 months before through 3 months after delivery. The primary study outcome was possible ED misdiagnosis of PAS, defined as an ED treat-and-release visit for a neurological complaint within the 30 days preceding PAS hospitalization. Standard tests of comparison were used to compare differences in characteristics between PAS patients with a possible ED stroke misdiagnosis versus those without.
Among 5,308,962 women hospitalized for labor and delivery, 1,656 (0.03%) were hospitalized for a stroke during the study period. Of the pregnant or postpartum women hospitalized for stroke, 79 (4.8%; median age, 30 years) had at least one preceding ED visit for a neurological symptom (possible misdiagnosis). Demographics and vascular comorbidities were similar between those with versus without possible misdiagnosis. There were also no differences in the average length of stay (7.5 versus 9.6 days, p=0.43) or discharge to home (63.3% versus 56.6%, p=0.24) after stroke.
Possible ED misdiagnosis occurred in nearly 1 of 20 cases of pregnancy-associated strokes in this multistate cohort though there were few of these strokes overall.
妊娠和产后时期与缺血性和出血性中风风险增加相关。急诊环境中妊娠相关中风（PAS）漏诊或延迟诊断的发生率尚不清楚。
我们对通过11个州（纽约州2006 - 2017年、佛罗里达州2005 - 2019年、3个州2016 - 2020年、6个州2016 - 2019年）所有非联邦急诊科和医院的行政索赔数据确定的因分娩住院的女性进行了一项回顾性队列研究。然后，我们使用经过验证的ICD - 9 - CM或ICD - 10 - CM编码，在从分娩前6个月到分娩后3个月的270天期间，确定因中风（缺血性或出血性）住院的女性。主要研究结果是PAS可能在急诊室被误诊，定义为在PAS住院前30天内因神经症状在急诊室接受治疗并出院的就诊。使用标准比较测试来比较可能在急诊室中风误诊的PAS患者与未误诊患者之间的特征差异。
在5308962名因分娩住院的女性中，1656名（0.03%）在研究期间因中风住院。在因中风住院的孕妇或产后女性中，79名（4.8%；中位年龄30岁）之前至少有一次因神经症状到急诊室就诊（可能误诊）。可能误诊者与未误诊者的人口统计学和血管合并症相似。中风后的平均住院时间（7.5天对9.6天，p = 0.43）或出院回家比例（63.3%对56.6%，p = 0.24）也没有差异。
在这个多州队列中，近20例妊娠相关中风中有1例可能在急诊室被误诊，尽管总体上这类中风很少。
