Abstract Body:
Introduction
Stroke is a leading cause of maternal morbidity and mortality, and hemorrhagic strokes account for up to half of these cases. Prior studies in non-maternal populations demonstrated that 9% of strokes are missed at initial ED presentation. We hypothesized that pregnant or postpartum patients with acute hemorrhagic stroke would have higher odds of delayed or missed diagnosis at the time of their initial presentation, compared with those with thrombotic strokes (arterial ischemic stroke [AIS] or cerebral venous thrombosis [CVT]).

Methods
We retrospectively identified female patients aged 18-50 years treated at 5 stroke centers between 1/1/2012 and 12/31/2021 with a confirmed diagnosis of AIS, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) or CVT. Patients who were pregnant or within 1 year of delivery at the time of stroke underwent medical chart review by vascular neurologists at each center. Medical encounters leading up to the stroke diagnosis were evaluated using the Safer Stroke-Dx instrument, a validated chart review tool to identify encounters with a missed opportunity to diagnose stroke. Encounters were categorized as “diagnostic delay” or “no diagnostic delay.” Patients with insufficient data for a determination were categorized as “no diagnostic delay.”

Results
A total of 121 patients were identified, of whom 48% had hemorrhagic stroke. Overall, 29% of patients experienced diagnostic delays. Age and vascular risk factors did not differ significantly between those with diagnostic delays and those without (Table). More patients in the group with diagnostic delays were Black (49% vs 31%) or Hispanic (23% vs 12%). The proportions of stroke subtype for diagnostic delays and no diagnostic delays are shown in the Figure. The odds of diagnostic delays were higher for individuals with hemorrhagic stroke compared to those with thrombotic strokes (OR 2.35, 95% CI 1.05-5.28). Adjusting for race and ethnicity did not change the effect.

Conclusions
The odds of experiencing a diagnostic delay were more than doubled for pregnant and postpartum patients with hemorrhagic strokes compared to those with thrombotic strokes. More research is needed to identify contributing factors to diagnostic delays in maternal stroke, and to develop tailored stroke screening tools to aid clinicians in diagnosing hemorrhagic stroke in the maternal population.