Few patients who were discharged from the emergency department (ED) with a nonspecific diagnosis of headache or back pain were readmitted for a serious neurologic condition or died as inpatients within 30 days of the initial visit, according to study results published in the Annals of Emergency Medicine.

This retrospective analysis examined population-based data from State Emergency Department Databases and State Inpatient Databases from 6 US states gathered between 2006 and 2012. The data of patients age ≥18 from these databases who were discharged from the ED with a diagnosis of atraumatic headache or back pain were included in the analysis.

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The primary study outcome was a composite of return ED visit and hospitalization for a primary diagnosis of a serious neurologic disorder or in-hospital death within 30 days of discharge from the ED.

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A total of 2,101,081 and 1,381,614 ED discharges with a nonspecific diagnosis of headache and a nonspecific diagnosis of back pain, respectively, were evaluated. Of the patients discharged with a nonspecific headache and back pain diagnosis, 0.5% and 0.2%, respectively, were re-admitted or died. The most common missed diagnoses in patients discharged with a headache diagnosis and back pain were ischemic stroke (18.1%) and intraspinal abscess (41.0%), respectively.

For both headache and back pain initial diagnoses, male gender, advanced age, non-Hispanic white race, and comorbidities (eg, HIV/AIDS, malignancy, and neurologic disorders), were found to be associated with a higher likelihood of readmission.

“In addition to the direct patient harm and long-term consequences associated with missed or delayed diagnosis of stroke, intraspinal abscesses, and other serious neurologic conditions, misdiagnosis also leads to substantial health care costs and litigation,” noted the study investigators.


Dubosh NM, Edlow JA, Goto T, Camargo CA Jr, Hasegawa K. Missed serious neurologic conditions in emergency department patients discharged with nonspecific diagnoses of headache or back pain [published online February 20, 2019]. Ann Emerg Med.