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Licensed Unlicensed Requires Authentication Published by De Gruyter July 4, 2019

Assessing diagnostic error in cerebral venous thrombosis via detailed chart review

  • Ava L. Liberman EMAIL logo , Ekaterina Bakradze , Daryl C. Mchugh , Charles C. Esenwa and Richard B. Lipton
From the journal Diagnosis



Diagnostic error in cerebral venous thrombosis (CVT) has been understudied despite the harm associated with misdiagnosis of other cerebrovascular diseases as well as the known challenges of evaluating non-specific neurological symptoms in clinical practice.


We conducted a retrospective cohort study of CVT patients hospitalized at a single center. Two independent reviewers used a medical record review tool, the Safer Dx Instrument, to identify diagnostic errors. Demographic and clinical factors were abstracted. We compared subjects with and without a diagnostic error using the t-test for continuous variables and the chi-square (χ2) test or Fisher’s exact test for categorical variables; an alpha of 0.05 was the cutoff for significance.


A total of 72 CVT patients initially met study inclusion criteria; 19 were excluded due to incomplete medical records. Of the 53 patients included in the final analysis, the mean age was 48 years and 32 (60.4%) were women. Diagnostic error occurred in 11 cases [20.8%; 95% confidence interval (CI) 11.8–33.6%]. Subjects with diagnostic errors were younger (42 vs. 49 years, p = 0.13), more often women (81.8% vs. 54.8%, p = 0.17), and were significantly more likely to have a past medical history of a headache disorder prior to the index CVT visit (7.1% vs. 36.4%, p = 0.03).


Nearly one in five patients with complete medical records experienced a diagnostic error. Prior history of headache was the only evaluated clinical factor that was more common among those with an error in diagnosis. Future work on distinguishing primary from secondary headaches to improve diagnostic accuracy in acute neurological disease is warranted.

Corresponding author: Ava L. Liberman, MD, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY 10467, USA, Phone: +(718)-920-6444, Fax: +(718) 654-0364

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: See disclosures.

  3. Employment or leadership: None declared.

  4. Honorarium: See disclosures.

  5. Disclosures: Dr. Liberman receives research support from the NIH grant K23NS107643. Dr. Bakradze received research support from the NIH grant U10 NS086531. Dr. Lipton receives research support from the NIH grants 2PO1 AG003949, 5U10 NS077308, RO1 NS082432, 1RF1 AG057531, RF1 AG054548, 1RO1 AG048642, and R56 AG057548. Dr. Lipton also receives support from the Migraine Research Foundation and the National Headache Foundation. He serves on the editorial board of Neurology, as senior advisor to Headache, and as associate editor to Cephalalgia. He has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics and Biohaven Holdings; serves as consultant, advisory board member, or has received honoraria from: American Academy of Neurology, Alder, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta. He receives royalties from Wolff’s Headache 7th and 8th Edition, Oxford Press University, 2009, Wiley and Informa.

  6. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Received: 2019-01-29
Accepted: 2019-05-27
Published Online: 2019-07-04
Published in Print: 2019-11-26

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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