Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study
Abstract Background Stroke incidence is reportedly increasing in younger populations, although the reasons for this are not clear. We explored possible reasons by quantifying trends in neurologically focused emergency department (ED) visits, classification of stroke vs. TIA, and imaging use. Methods...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-021-02172-1 |
| _version_ | 1818866183642808320 |
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| author | Abhinav J. Appukutty Lesli E. Skolarus Mellanie V. Springer William J. Meurer James F. Burke |
| author_facet | Abhinav J. Appukutty Lesli E. Skolarus Mellanie V. Springer William J. Meurer James F. Burke |
| author_sort | Abhinav J. Appukutty |
| collection | DOAJ |
| description | Abstract Background Stroke incidence is reportedly increasing in younger populations, although the reasons for this are not clear. We explored possible reasons by quantifying trends in neurologically focused emergency department (ED) visits, classification of stroke vs. TIA, and imaging use. Methods We performed a retrospective, serial, cross-sectional study using the National Hospital Ambulatory Medical Care Survey to examine time trends in age-stratified primary reasons for visit, stroke/TIA diagnoses, and MRI utilization from 1995 to 2000 and 2005–2015. Results Five million eight hundred thousand ED visits with a primary diagnosis of stroke (CI 5.3 M–6.4 M) were represented in the data. The incidence of neurologically focused reason for visits (Neuro RFVs) increased over time in both the young and in older adults (young: + 111 Neuro RFVs/100,000 population/year, CI + 94 − + 130; older adults: + 70 Neuro RFVs/100,000 population/year, CI + 34 − + 108). The proportion of combined stroke and TIA diagnoses decreased over time amongst older adults with a Neuro RFV (OR 0.95 per year, p < 0.01, CI 0.94–0.96) but did not change in the young (OR 1.00 per year, p = 0.88, CI 0.95–1.04). Within the stroke/TIA population, no changes in the proportion of stroke or TIA were identified. MRI utilization rates amongst patients with a Neuro RFV increased for both age groups. Conclusions We found, but did not anticipate, increased incidence of neurologically focused ED visits in both age groups. Given the lower pre-test probability of a stroke in younger adults, this suggests that false positive stroke diagnoses may be increasing and may be increasing more rapidly in the young than in older adults. |
| first_indexed | 2024-12-19T10:59:24Z |
| format | Article |
| id | doaj.art-03b894030fad45d89c21f2bdcc9f9025 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-19T10:59:24Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-03b894030fad45d89c21f2bdcc9f90252022-12-21T20:24:41ZengBMCBMC Neurology1471-23772021-04-0121111010.1186/s12883-021-02172-1Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional studyAbhinav J. Appukutty0Lesli E. Skolarus1Mellanie V. Springer2William J. Meurer3James F. Burke4University of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolAbstract Background Stroke incidence is reportedly increasing in younger populations, although the reasons for this are not clear. We explored possible reasons by quantifying trends in neurologically focused emergency department (ED) visits, classification of stroke vs. TIA, and imaging use. Methods We performed a retrospective, serial, cross-sectional study using the National Hospital Ambulatory Medical Care Survey to examine time trends in age-stratified primary reasons for visit, stroke/TIA diagnoses, and MRI utilization from 1995 to 2000 and 2005–2015. Results Five million eight hundred thousand ED visits with a primary diagnosis of stroke (CI 5.3 M–6.4 M) were represented in the data. The incidence of neurologically focused reason for visits (Neuro RFVs) increased over time in both the young and in older adults (young: + 111 Neuro RFVs/100,000 population/year, CI + 94 − + 130; older adults: + 70 Neuro RFVs/100,000 population/year, CI + 34 − + 108). The proportion of combined stroke and TIA diagnoses decreased over time amongst older adults with a Neuro RFV (OR 0.95 per year, p < 0.01, CI 0.94–0.96) but did not change in the young (OR 1.00 per year, p = 0.88, CI 0.95–1.04). Within the stroke/TIA population, no changes in the proportion of stroke or TIA were identified. MRI utilization rates amongst patients with a Neuro RFV increased for both age groups. Conclusions We found, but did not anticipate, increased incidence of neurologically focused ED visits in both age groups. Given the lower pre-test probability of a stroke in younger adults, this suggests that false positive stroke diagnoses may be increasing and may be increasing more rapidly in the young than in older adults.https://doi.org/10.1186/s12883-021-02172-1StrokeStroke in the youngEpidemiologyDiagnosisFalse positive |
| spellingShingle | Abhinav J. Appukutty Lesli E. Skolarus Mellanie V. Springer William J. Meurer James F. Burke Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study BMC Neurology Stroke Stroke in the young Epidemiology Diagnosis False positive |
| title | Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study |
| title_full | Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study |
| title_fullStr | Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study |
| title_full_unstemmed | Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study |
| title_short | Increasing false positive diagnoses may lead to overestimation of stroke incidence, particularly in the young: a cross-sectional study |
| title_sort | increasing false positive diagnoses may lead to overestimation of stroke incidence particularly in the young a cross sectional study |
| topic | Stroke Stroke in the young Epidemiology Diagnosis False positive |
| url | https://doi.org/10.1186/s12883-021-02172-1 |
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