{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:09:00Z","timestamp":1787022540606,"version":"build-2736575974"},"reference-count":55,"publisher":"Walter de Gruyter GmbH","issue":"1","funder":[{"name":"Armstrong Institute Center for Diagnostic Excellence"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dx-2020-0124_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Isolated dizziness is a challenging stroke presentation in the emergency department, but little is known about this problem in other clinical settings. We sought to compare stroke hospitalizations after treat-and-release clinic visits for purportedly \u201cbenign dizziness\u201d between general and specialty care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2020-0124_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a population-based retrospective cohort study from a national database. We included clinic patients with a first incident treat-and-release visit diagnosis of non-specific dizziness\/vertigo or a peripheral vestibular disorder (ICD-9-CM 780.4 or 386.x [not 386.2]). We compared general care (internal medicine, family medicine) vs. specialty care (neurology, otolaryngology) providers. We used propensity scores to control for baseline stroke risk differences unrelated to dizziness diagnosis. We measured excess (observed&gt;expected) stroke hospitalizations in the first 30\u00a0d (i.e.,\u00a0missed strokes associated with an adverse event).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2020-0124_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We analyzed 144,355 patients discharged with \u201cbenign dizziness\u201d (n=117,117 diagnosed in general care; n=27,238 in specialty care). After propensity score matching, patients in both groups were at higher risk of stroke in the first 30\u00a0d (rate difference per 10,000 treat-and-release visits for \u201cbenign dizziness\u201d 24.9 [95% CI 18.6\u201331.2] in general care and 10.6 [95% CI 6.3\u201314.9] in specialty care). Short-term stroke risk was higher in general care than specialty care (relative risk, RR 2.2, 95% CI 1.5\u20133.2) while the long-term risk was not significantly different (RR 1.3, 95% CI 0.9\u20131.9), indicating higher misdiagnosis-related harms among dizzy patients who initially presented to generalists after adequate propensity matching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2020-0124_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Missed stroke-related harms in general care were roughly twice that in specialty care. Solutions are needed to address this care gap.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dx-2020-0124","type":"journal-article","created":{"date-parts":[[2021,6,19]],"date-time":"2021-06-19T18:09:58Z","timestamp":1624126198000},"page":"96-106","source":"Crossref","is-referenced-by-count":16,"title":["Stroke hospitalization after misdiagnosis of \u201cbenign dizziness\u201d is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods"],"prefix":"10.1515","volume":"9","author":[{"given":"Tzu-Pu","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Neurology\/Neuro-Medical Scientific Center , Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , Taichung , Taiwan"},{"name":"Department of Neurology , School of Medicine, Tzu Chi University , Hualien , Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand K.","family":"Bery","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine , University of Ottawa , Ottawa , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisztian","family":"Sebestyen","sequence":"additional","affiliation":[{"name":"Department of Surgery , Johns Hopkins University School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hung","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Research , Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , Taichung , Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava L.","family":"Liberman","sequence":"additional","affiliation":[{"name":"Department of Neurology , Albert Einstein College of Medicine , Bronx , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Newman-Toker","sequence":"additional","affiliation":[{"name":"Department of Neurology , Johns Hopkins Hospital , Pathology Building 2-221, 600 North Wolfe Street , Baltimore , MD 21287-6921 , USA"},{"name":"Armstrong Institute Center for Diagnostic Excellence, Johns Hopkins University School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,6,21]]},"reference":[{"key":"2025121207265125165_j_dx-2020-0124_ref_001","doi-asserted-by":"crossref","unstructured":"Balogh, E, Miller, BT, Ball, J, Institute of Medicine (U.S.). Committee on diagnostic error in health care. Improving diagnosis in health care. Washington, DC: The National Academies Press; 2015, vol xxvii:444 p.","DOI":"10.17226\/21794"},{"key":"2025121207265125165_j_dx-2020-0124_ref_002","doi-asserted-by":"crossref","unstructured":"Singh, H, Meyer, AN, Thomas, EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf 2014;23:727\u201331. https:\/\/doi.org\/10.1136\/bmjqs-2013-002627.","DOI":"10.1136\/bmjqs-2013-002627"},{"key":"2025121207265125165_j_dx-2020-0124_ref_003","doi-asserted-by":"crossref","unstructured":"Gunderson, CG, Bilan, VP, Holleck, JL, Nickerson, P, Cherry, BM, Chui, P, et al.. Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis. 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