Diagnosis of Bell's Palsy in ER Is Usually Accurate
Increasing age, black race, diabetes, and use of imaging associated with incorrect diagnosis
WEDNESDAY, July 31 (HealthDay News) -- The incidence of incorrect diagnoses of Bell's palsy in the emergency department with subsequent alternative diagnosis is low, according to a study published online July 29 in the Annals of Emergency Medicine.
Jahan Fahimi, M.D., M.P.H., of the University of California in San Francisco, and colleagues performed a retrospective cohort study using data for 2005 to 2011 from the California Office of Statewide Health Planning and Development. Misdiagnosis of Bell's palsy and factors associated with alternative diagnosis on follow-up were assessed.
The researchers found that a total of 43,979 adult patients (median age, 45 years) were diagnosed with Bell's palsy in the emergency department. At 90 days, 356 patients (0.8 percent) received an alternative diagnosis. Increasing age (hazard ratio [HR], 1.11 for every 10 years), black race (HR, 1.68), diabetes (HR, 1.46), and use of computed tomography or magnetic resonance imaging (HR, 1.43) made alternative diagnosis more likely, whereas private insurance (HR, 0.65) made it less likely. Collectively, stroke, herpes zoster, Guillain-Barré syndrome, and otitis media accounted for 85.4 percent of all alternative diagnoses.
"Emergency providers adequately diagnose Bell's palsy in the emergency department, with a low rate of missing serious or life-threatening alternate diagnoses based on subsequent 90-day follow-up," the authors write.