Diagnostic errors lead to death or disability for an estimated 150 000 patients in the United States each year.1 The emergency department is a known high-risk location for misdiagnosis.2 Missed ischemic stroke and brain hemorrhage are recognized sources of diagnostic error, with approximately 9% of cerebrovascular events missed at first emergency department contact,3 including an estimated 20% of subarachnoid hemorrhages in patients presenting with normal mental status.4 Because effective treatments are available, diagnostic delays increase morbidity and mortality 3- to 8-fold,4,5 so accurate early diagnosis is important.
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The Rational Clinical Examination
Patients with the sudden onset of an extremely severe headache (so severe that they immediately...
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