Background: Missed or delayed diagnosis of acute ischaemic stroke may prevent individuals from accessing hyperacute stroke interventions. Stroke presenting with a reduced level of consciousness (RLOC) may result in delayed or missed diagnosis.
Aims: This systematic review aims to determine the frequency, reasons for, and consequences of missed stroke diagnoses due to RLOC.
Methods: A systematic review was conducted of the databases PubMed, EMBASE, and Cochrane library in accordance with the PRISMA guidelines. The systematic review was registered prospectively on PROSPERO.
Results: Initial searches returned 1162 results, of which 6 fulfilled inclusion criteria. Most identified studies demonstrated that patients with ischaemic stroke with RLOC were at an increased risk of missed or delayed diagnosis. There may have been delays to certain stroke investigations and interventions. The delays included the lack of urgent magnetic resonance imaging (MRI) and lack of firm diagnosis for patients with RLOC. There was limited evidence regarding the outcomes of patients with stroke and RLOC who have delayed diagnoses. The available evidence suggested that outcomes of these patients may be poor. Patients with thalamic strokes may experience minimally conscious states and thalamic dementia. The included studies have not evaluated but have suggested urgent MRI access, educational interventions, and protocolisation of the evaluation of RLOC.
Conclusion: Patients with ischaemic stroke with RLOC are at risk of having their diagnosis missed or delayed, which may be associated with poor outcomes. Additional research is required regarding the reasons for and strategies to prevent these missed diagnoses.