Table 3.
Number of diagnostic errors, change of diagnosis rates, missed dangerous diagnoses and mimics
| ED diagnoses | Total ED | No of diagnostic errors | Change of diagnosis* | No of missed strokes or TIA | Frequency of undiagnosed underlying diseases (top 3)† |
| Stroke/minor stroke | 132 | 18 | 13.6% | 5 (TIA) | TIA (5) Acute unilateral vestibulopathy (4) Dysautonomia (1) |
| Acute unilateral vestibulopathy (eg, vestibular neuritis) | 89 | 14 | 15.7% | 3 | Stroke/minor stroke (2) Menière’s disease (2) Others (2) |
| TIA | 49 | 15 | 30.6% | 7 (strokes) | Stroke/minor stroke (7) BPPV (1) Metabolic (1) Medical side effects (1) |
| BPPV | 28 | 8 | 28.6% | 2 | Acute unilateral vestibulopathy (3) Stroke/minor stroke (2) Others (2) |
| Menière’s disease | 15 | 4 | 26.7% | 0 | Acute unilateral vestibulopathy (3) Labyrinthitis (1) |
| Tumour | 14 | 1 | 7.1% | 0 | 0 |
| Vestibular migraine | 12 | 3 | 25.0% | 0 | Others (2) PPPD (1) |
| Dysautonomia | 9 | 3 | 33.3% | 0 | Others (2) Heart disease (2) Medical side effects (1) |
| Labyrinthitis | 7 | 2 | 28.6% | 0 | Acute unilateral vestibulopathy (1) Acoustic neuroma (1) |
| Infectious disease | 6 | 3 | 50.0% | 0 | Acute unilateral vestibulopathy (3) |
| Heart disease | 5 | 0 | 0.0% | 0 | 0 |
| PPPD | 5 | 0 | 0.0% | 0 | 0 |
| Others‡ | 42 | 4 | 9.5% | 0 | Dysautonomia (2) BPPV (1) Tumour (1) |
| Unknown | 249 | 145 | 58.2% | 23 | Acute unilateral vestibulopathy (35) Vestibular migraine (22) Stroke/minor stroke (14) TIA (9) |
| Total | 662 | 222 | 31.4% | 40 |
*Since multiple answers were possible for the diagnoses, the number of diagnostic errors did not necessarily correspond to the proportion of change of diagnosis. The rate of changes of diagnoses at follow-up is calculated as follows: 100*(1−correct diagnoses/total diagnoses ED).
†Undiagnosed underlying diseases: this column shows the most frequently changed diagnosis based on the follow-up examination.
‡Diagnoses less frequent than five are not listed in the table.
BPPV, benign paroxysmal positional vertigo; ED, emergency department; PPPD, persistent postural-perceptual dizziness; TIA, transient ischaemic attack.