Missed Strokes Using Computed Tomography Imaging in Patients With Vertigo Population-Based Cohort Study
Missed Strokes Using Computed Tomography Imaging in Patients With Vertigo Population-Based Cohort Study
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DOI：
10.1161/strokeaha.114.007087
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发表时间：
2015-01-01
期刊：
影响因子：
8.3
通讯作者：
Atzema, Clare L.
中科院分区：
文献类型：
--
作者：
Grewal, Keerat;Austin, Peter C.;Atzema, Clare L.
背景和目的：本研究的目的是确定急诊科(ED)诊断为周围性眩晕的患者在急诊科接受CT头部成像的比例，并使用CT成像检查是否漏诊中风。方法：这项基于人群的回顾性队列研究评估了2006年4月至2011年3月在加拿大安大略省的急诊科出院的诊断为周围性眩晕的患者。通过倾向计分方法将接受CT成像(暴露)的患者与没有接受CT成像(未暴露)的患者进行匹配。如果进行，CT成像被推定为中风阴性，因为脑干/小脑中风会导致住院。结果：在41794名符合条件的患者中，8596人(20.6%)接受了ED头部CT成像，其中99.8%的患者能够与对照组匹配。在暴露患者中，25人(0.29%)在30天内因中风住院，而匹配的非暴露患者中有11人(0.13%)。暴露与未暴露患者发生30天和90天中风的相对风险分别为2.27(95%可信区间，1.12-4.62)和1.94(95%可信区间，1.10-3.43)。1年后两组间差异无统计学意义。在暴露的患者中，中风发生的中位数为32.0d(四分位数范围，4.0d-33.0d)，而非暴露患者的中位数为105d(四分位数范围，11.5%-204.5)。结论--在安大略省，五分之一的周围性眩晕患者接受了指南中不推荐的成像，并且成像与遗漏中风有关。
Background and Purpose-The purpose of this study was to determine the proportion of emergency department (ED) patients with a diagnosis of peripheral vertigo who received computed tomography (CT) head imaging in the ED and to examine whether strokes were missed using CT imaging.Methods-This population-based retrospective cohort study assessed patients who were discharged from an ED in Ontario, Canada, with a diagnosis of peripheral vertigo, April 2006 to March 2011. Patients who received CT imaging (exposed) were matched by propensity score methods to patients who did not (unexposed). If performed, CT imaging was presumed to be negative for stroke because brain stem/cerebellar stroke would result in hospitalization. We compared the incidence of stroke within 30, 90, and 365 days subsequent to ED discharge between groups, to determine whether the exposed group had a higher frequency of early strokes than the matched unexposed group.Results-Among 41 794 qualifying patients, 8596 (20.6%) received ED head CT imaging, and 99.8% of these patients were able to be matched to a control. Among exposed patients, 25 (0.29%) were hospitalized for stroke within 30 days when compared with 11 (0.13%) among matched nonexposed patients. The relative risk of a 30- and 90-day stroke among exposed versus unexposed patients was 2.27 (95% confidence interval, 1.12-4.62) and 1.94 (95% confidence interval, 1.10-3.43), respectively. There was no difference between groups at 1 year. Strokes occurred at a median of 32.0 days (interquartile range, 4.0-33.0 days) in exposed patients, compared with 105 days (interquartile range, 11.5-204.5) in unexposed patients.Conclusions-One fifth of patients diagnosed with peripheral vertigo in Ontario received imaging that is not recommended in guidelines, and that imaging was associated with missed strokes.