 |
|
Initial Misdiagnosis and Outcome After Subarachnoid Hemorrhage
Robert G. Kowalski, BS;
Jan Claassen, MD;
Kurt T. Kreiter, PhD;
Joseph E. Bates, MA;
Noeleen D. Ostapkovich, MS;
E. Sander Connolly, MD;
Stephan A. Mayer, MD
JAMA. 2004;291:866-869.
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.
Author Affiliations: Division of Stroke and Critical Care Neurology, Department of Neurology (Mssrs Kowalski and Bates, Ms Ostapkovich, and Drs Claassen, Kreiter, and Mayer), and Department of Neurosurgery (Drs Connolly and Mayer), Columbia University College of Physicians and Surgeons, New York, NY.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Awareness of Stroke Warning Symptoms--13 States and the District of Columbia, 2005
JAMA 2008;300:274-276.
FULL TEXT
Treatment of Brain Aneurysms
SCHONFELD and McMULLEN
radtech 2008;79:515-531.
ABSTRACT
| FULL TEXT
Emergency department evaluation of sudden, severe headache
Breen et al.
QJM 2008;101:435-443.
ABSTRACT
| FULL TEXT
Detection of Aneurysms by 64-Section Multidetector CT Angiography in Patients Acutely Suspected of Having an Intracranial Aneurysm and Comparison with Digital Subtraction and 3D Rotational Angiography
McKinney et al.
Am. J. Neuroradiol. 2008;29:594-602.
ABSTRACT
| FULL TEXT
Missed Diagnosis of Subarachnoid Hemorrhage in the Emergency Department
Vermeulen and Schull
Stroke 2007;38:1216-1221.
ABSTRACT
| FULL TEXT
Diagnosis of Subarachnoid Hemorrhage: Are We Doing Better?
Edlow
Stroke 2007;38:1129-1131.
FULL TEXT
Advances in Subarachnoid Hemorrhage
Feigin and Findlay
Stroke 2006;37:305-308.
FULL TEXT
Aneurysmal Subarachnoid Hemorrhage
Suarez et al.
NEJM 2006;354:387-396.
FULL TEXT
Errors of Omission
Berlin
Am. J. Roentgenol. 2005;185:1416-1421.
FULL TEXT
Misdiagnosis of Subarachnoid Hemorrhage
JWatch Emergency Med. 2004;2004:5-5.
FULL TEXT
Consequences of Misdiagnosing Subarachnoid Hemorrhage
JWatch General 2004;2004:6-6.
FULL TEXT
|
