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JAMA. 2004 Feb 18;291(7):866-9.

Initial misdiagnosis and outcome after subarachnoid hemorrhage.

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  • 1Division of Stroke and Critical Care Neurology, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Abstract

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.

PMID:
14970066
[PubMed - indexed for MEDLINE]
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