Junior doctors 'missing key stroke diagnosis tests'

Sub Arachnoid Haemorrhages are responsible for only 5% of strokes, but 25% of stroke deaths

Only 25% of all junior doctors in A&E units know the key tests for diagnosing the most lethal form of stroke, according to a survey.

Sub Arachnoid Haemorrhage (SAH) is a bleed just under the skull's surface.

Even though it only accounts for 5% of all strokes, it is responsible for 25% of all deaths from the illness.

Researchers in Stoke-on-Trent undertook a telephone poll of junior doctors in A&E units across England between 2008 and 2009.

The results of University Hospital North Staffordshire's survey have been revealed after a Freedom of Information request by BBC Midlands Today.

The research project's aim was to minimise the number of misdiagnoses, with only half of SAH patients correctly diagnosed on their first visit to a doctor.

The "gold standard" test for patients who complain of a sudden headache should be a CT scan and a lumbar puncture - and if these are clear, they can be discharged.

However, the survey of 178 junior doctors working the night shift found only 25% knew this gold standard.

Court settlement

The research also found that 20% of registrars had never heard of a thunder clap headache - the most common symptom of SAH.

Some 84% of junior doctors also did not know how effective a CT scan was in diagnosing early bleeding.

In 2009, at the time Dr Vino Apok and Dr Brendan Davies were conducting their research at University Hospital North Staffordshire, 52-year-old June Harriman was told by the hospital's A&E department she had a migraine and was sent home.

She returned a few days later after an optician told her she was having a stroke. After nine hours in A&E she collapsed and died.

Last year her family received a six figure sum in compensation following an out of court settlement.

Dr Munchi Choksey, a consultant neurosurgeon at University Hospitals, Coventry said: "If a woman has a lump in their breast, she is screened for breast cancer. The same should apply with SAH.

"If you have a sudden agonising headache, you should be screened for the possibility of an aneurysm because if you walk into hospital with SAH, the chances are [if screened] that you will walk out of hospital. If you go into hospital in a coma, the chances are, you are going to die."

Dr Clare Walton from The Stroke Association said that while rare, SAH strokes were often fatal.

She added: "Quick diagnosis and treatment is therefore absolutely essential.

"It's worrying to hear that so few junior doctors in this study were aware of the recommended diagnostic tests for patients admitted with a sudden and severe headache.

"More needs to be done to ensure every stroke patient is identified and gets the urgent treatment they need."