Table 1.
Calibration Gap for Missed Stroke in Dizziness for an Average Full‐time Clinical ED Physician
| Parameter | No. per year | No. per decade |
|---|---|---|
| ED visits | 60,000 | 600,000 |
| Dizziness visits (~3%) | 1,800 | 18,000 |
| Dizziness patients while ‘on shift’ (~16%–18%) | 300 | 3,000 |
| Dizziness while on shift due to stroke (~3%–5%) | 12 | 120 |
| Obvious strokes (e.g., with neurologic signs) recognized (~60%a) | 7 | 70 |
| Subtle strokes (e.g., isolated vertigo with only eye/gait signs) missed (~40%a) | 5 | 50 |
| Untreated missed strokes returning with major stroke < 90 days (~15%–20%) | 1 | 10 |
| Missed strokes returning with major stroke to the same hospital (~60%) | < 1 | 6 |
| Missed strokes returning with major stroke while “on shift” (~16%–18%) | ~0 | 1 |
| Total missed strokes (actual count) | 5 | 50 |
| Total missed strokes w/direct feedback for calibration (perceived count) | ~0 | 1 |
a
The precise frequency of ED stroke misdiagnosis in dizziness is unknown, but best estimates suggest it is ~40%11