Diagnostic Accuracy for Acute Intracranial Events in the ED

Researchers performed a meta-analysis of 23 studies (15,721 patients) published from 1995 to 2016 to determine the overall diagnostic accuracy for acute stroke or related syndromes in patients presenting to the emergency department (ED).

Overall sensitivity (91%) and specificity (93%) were relatively high, yet approximately 9% of acute cerebrovascular events (acute stroke, transient ischemic attack, and subarachnoid hemorrhage) were missed at initial ED presentation. The rate of missed diagnosis rose to an estimated 24% to 60% when presenting symptoms were nonspecific (e.g., dizziness), transient, or mild (e.g., normal mental status).