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The importance of considering stroke as a diagnosis in A&E and what more can be done to prevent patients suffering injury as a result of misdiagnosis.
By Judith Leach
There is a great deal written in the media in relation to recognising the signs and symptoms of stroke, timely treatment and the rehabilitation needed following a stroke. There is however very little research on how many cases with stroke related symptoms are not being diagnosed correctly in hospital.
Many major hospitals now boast specialist stroke facilities and employ specialist stroke teams including nurses or physiotherapists. These stroke teams are often the first contact the patient has in A&E. There appear to be no nationally approved courses for such stroke team members who are usually trained in-house resulting is greatly varying levels of expertise.
In many cases the lack of skill and/or a failure to refer for senior medical input results in a failure to arrange for scanning or to diagnose a stroke. Such patients are often discharged inappropriately without treatment only to suffer a further catastrophic stroke hours later at home. If a patient is not diagnosed correctly then they will never make it onto the often excellent stroke care pathways.
It is essential that all patients presenting with a possible stroke have access to a suitably qualified clinician who has the appropriate level of skill to confirm a stroke or, more importantly to exclude a stroke before a decision is made to discharge a patient home.
A CT scan is done for the main purpose of excluding a bleed i.e. a haemorrhagic stroke. A patient can then be assessed for clot busting treatment (thrombolysis). There is only a small window of opportunity from onset of symptoms to give thrombolysis. Centres vary but this can be between 3 and 4 hours generally. The earlier it is given the better the outcome can be.
Our Clinical Negligence Team are experienced in dealing with all aspects of brain injury and lawyers in our team, such as myself, have a particular expertise in stroke misdiagnosis cases.
We are often asked to investigate cases where there is a failure to diagnose a stroke in Accident & Emergency, and often these are because they have been seen by someone who does not recognise the patient’s symptoms as possibly relating to a stroke. If a patient is sent home inappropriately and then suffers a further catastrophic stroke hours later then they can suffer serious brain injury which will affect them for the rest of their life, sometimes being unable to work and generally being dependant on others. All of this could have been avoided if they had been properly assessed when they first attended A&E.
Based on my experience of these cases it seems clear to me that further training of staff working in A&E is required to ensure they are fully alert to the possibility of stroke as a diagnosis when a patient presents with relevant symptoms. This will ensure specialist input is called at the earliest opportunity and either stroke being correctly excluded as a diagnosis or timely treatment given to try and prevent the patient suffering devastating injury. Perhaps if further research was available as to the number of patients who are not properly diagnosed in hospital it would lead to this being identified as an area for improved training.
If you would like to discuss a case where there was a failure to diagnose a stroke or provide timely treatment then please get in touch with me to discuss your options.