Initial misdiagnosis and outcome after subarachnoid hemorrhage
Initial misdiagnosis and outcome after subarachnoid hemorrhage
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DOI：
10.1001/jama.291.7.866
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发表时间：
2004-02-18
影响因子：
120.7
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Kowalski, RG;Claassen, J;Mayer, SA
如果蛛网膜下腔出血（SAH）得到紧急治疗，死亡率和发病率可以降低。研究对象：1996年8月至2001年8月在一家三级城市医院住院的482例SAH患者的初始队列。患者与医疗专业人员的初次接触。功能结果进行了评估，在3个月和12个月的修改后的兰金量表;生活质量（QOL），与疾病的影响Profile.Results五十六例（12%）最初被误诊，包括42 221（19%）的精神状态正常的人在第一次接触。偏头痛或紧张性头痛（36%）是最常见的误诊，未能获得计算机断层扫描（CT）扫描是最常见的诊断错误（73%）。22例患者（39%）在正确诊断前发生神经系统并发症，包括12例患者（21%）发生再出血。正常的精神状态、小的SAH体积和右侧动脉瘤位置与误诊独立相关。在第一次接触时精神状态正常的患者中，误诊与3个月时的生活质量较差以及12个月时死亡或严重残疾的风险增加有关。结论在这项研究中，SAH的误诊发生在12%的患者中，并且与较小的出血和正常的精神状态有关。在最初表现良好的个体中，误诊与死亡率和发病率的增加有关。对于有轻微症状提示SAH的患者，CT扫描的低阈值可能会减少误诊的频率。
Context Mortality and morbidity can be reduced if aneurysmal subarachnoid hemorrhage (SAH) is treated urgently.Objective To determine the association of initial misdiagnosis and outcome after SAH.Design, Setting, and Participants Inception cohort of 482 SAH patients admitted to a tertiary care urban hospital between August 1996 and August 2001.Main Outcome Measures Misdiagnosis was defined as failure to correctly diagnose SAH at a patient's initial contact with a medical professional. Functional outcome was assessed at 3 and 12 months with the modified Rankin Scale; quality of life (QOL), with the Sickness Impact Profile.Results Fifty-six patients (12%) were initially misdiagnosed, including 42 of 221 (19%) of those with normal mental status at first contact. Migraine or tension headache (36%) was the most common incorrect diagnosis, and failure to obtain a computed tomography (CT) scan was the most common diagnostic error (73%). Neurologic complications occurred in 22 patients (39%) before they were correctly diagnosed, including 12 patients (21%) who experienced rebleeding. Normal mental status, small SAH volume, and right-sided aneurysm location were independently associated with misdiagnosis. Among patients with normal mental status at first contact, misdiagnosis was associated with worse QOL at 3 months and an increased risk of death or severe disability at 12 months.Conclusions In this study, misdiagnosis of SAH occurred in 12% of patients and was associated with a smaller hemorrhage and normal mental status. Among individuals who initially present in good condition, misdiagnosis is associated with increased mortality and morbidity. A low threshold for CT scanning of patients with mild symptoms that are suggestive of SAH may reduce the frequency of misdiagnosis.