Identifying Missed Diagnostic Opportunities in Maternal Stroke

Area of Science:

• Neurology
• Obstetrics & Gynecology
• Public Health

Background:

• Pregnancy-associated stroke can present with subtle, nonfocal symptoms, increasing the risk of missed diagnostic opportunities (MDO).
• Timely and accurate diagnosis of stroke in pregnant and postpartum individuals is critical for effective management and improved outcomes.

Purpose of the Study:

• To determine the proportion of pregnancy-associated stroke cases with missed diagnostic opportunities (MDO).
• To identify factors contributing to MDO in pregnancy-related stroke.
• To highlight the need for improved diagnostic strategies and clinician education.

Main Methods:

• Retrospective study of 135 patients aged 18-50 years with pregnancy-related stroke across 5 US centers (2012-2021).
• Cases included arterial ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral venous thrombosis.
• Validated tool (Safer Stroke-Dx) used by vascular neurologists to assess MDO.

Main Results:

• 27% of patients (37 of 135) experienced MDO.
• Patients with MDO were more likely to have hemorrhagic strokes and had higher rates of prior medical encounters.
• Key factors for MDO included failure to recognize symptoms (84%) and omission of neuroimaging (81%), despite typical presentations.

Conclusions:

• Missed diagnostic opportunities are common in pregnancy-associated stroke, affecting over a quarter of patients.
• There is a significant need for enhanced clinician education, especially for non-neurologists, to improve stroke recognition and diagnosis in this population.
• Improving diagnostic pathways can lead to earlier intervention and potentially better outcomes for pregnant and postpartum individuals experiencing stroke.