Abstract
Abstract 155: Misdiagnosis in Cervical Artery Dissection: Analysis of STOP-CAD Study
Stroke (1970), Vol.56(Suppl_1)
02/2025
DOI: 10.1161/str.56.suppl_1.155
Abstract
Abstract only Background: Cervical artery dissection (CeAD) accounts for a quarter of strokes in young adults. Clinical presentation is often non-specific, leading to a significant proportion of cases being misdiagnosed. This study aims to identify factors contributing to potential misdiagnosis and to assess the impact of misdiagnosis on patient outcomes. Methods: This is a secondary analysis of the Antithrombotics for Stroke Prevention in Cervical Artery Dissection (STOP-CAD), a multicenter cross-sectional international retrospective study of adult patients presenting to an acute care hospital and diagnosed with CeAD. Misdiagnosis of CeAD was determined by identifying any medical encounters for symptoms attributable to the CeAD within the 30 days preceding the diagnosis. Strokes occurring during the interval between the initial misdiagnosis encounter and the final diagnosis date were recorded. We used multivariable regression to identify factors associated with misdiagnosis. The primary outcome was ischemic stroke after CeAD diagnosis. Secondary outcomes included death and excellent functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score <2. Multivariable logistic regression analysis was used to assess the association between misdiagnosis and above outcomes. Results: Of the 4023 patients included in the STOP-CAD study, 4012 were included in this analysis; mean age was 47.5 (+/-13.3) years and 44.6% (1788) were woman. Among these, 663 patients (16.5%) had medical encounters within the 30 days preceding the diagnosis (misdiagnosis group) and 224 (33.8%) had an ischemic stroke after the initial medical encounter but before the CeAD diagnosis. Misdiagnosed patients were younger (OR 0.89, 95% CI 0.83-0.95, p<0.001), more likely to have a history of migraine (OR 1.35, 95% CI 1.09-1.67, p=0.007), present with headache (OR 1.43, 95% CI 1.19-1.71, p<0.001) and less likely to present with signs and symptoms concerning for cerebral ischemia (OR 0.68, 95% CI 0.56-0.83, p<0.001). There was no significant difference in outcomes between the two groups in adjusted analyses: ischemic stroke (aOR 0.96, 95%CI 0.63-1.48, p=0.87), mRS<2 (aOR 1.04, 95% CI 0.76-1.44, p=0.80) and death (aOR 0.58, 95% CI 0.19-1.8, p=0.34). Conclusion: One in six patients who were ultimately diagnosed with CeAD experienced a possible misdiagnosis. Factors associated with a higher likelihood of misdiagnosis included younger age, a history of migraine, and a non-ischemic clinical presentation.
Details
- Title: Subtitle
- Abstract 155: Misdiagnosis in Cervical Artery Dissection: Analysis of STOP-CAD Study
- Creators
- Ekaterina Bakradze - University of Alabama at BirminghamLiqi Shu - Brown UniversityShadi Yaghi - Brown UniversityThanh Lam Tran - Hackensack Meridian HealthRoss Crandall - University of Colorado DenverEvan Lester - Cornell UniversityDaniel Mandel - West Virginia UniversityJames Siegler - University of ChicagoMary Penckofer - Cooper Medical School of Rowan UniversityAva Liberman - Cornell UniversityThalia Field - University of British ColumbiaFarhan Khan - Brown UniversityWayneho Kam - Duke University HospitalBrian Mac Grory - Duke University HospitalFaddi Saleh Velez - University of OklahomaNils Henninger - University of Massachusetts Chan Medical SchoolCheran Elangovan - University of Tennessee Health Science CenterBalaji Krishnaiah - University of Tennessee Health Science CenterPreet Gandhi - University of British ColumbiaReza Bavarsad Shahripour - University of California, San DiegoMalik Ghannam - University of IowaMirjam Heldner - University of BernAntonenko Katheryna - University Hospital of BernAaron Rothstein - University of PennsylvaniaIssa Metanis - Hadassah Medical CenterEdgar Samaniego - University of IowaMichele Romoli - Ospedale “M. Bufalini” di CesenaZedde Marialuisa - Azienda Sanitaria Unità Locale di Reggio EmiliaThanh Nguyen - Boston Medical CenterFarid Khasiyev - Saint Louis UniversityOssama Khazaal - Temple University HospitalMohammad AlMajali - Mercy St. Vincent Medical CenterAdeel Zubair - Yale UniversityMarwa Elnazeir - University of LouisvilleJoao Pedro Marto - Hospital de Egas MonizOmair ul haq Lodhi - University of Minnesota SystemAhmad Nehme - Université de Caen NormandieJames Giles - Yale UniversitySetareh Salehi Omran - University of Colorado Denver
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.56(Suppl_1)
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- DOI
- 10.1161/str.56.suppl_1.155
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/2025
- Academic Unit
- Radiology; Neurology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984786279602771
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