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[Mistaken diagnosis in subarachnoid bleeding. A study of 154 cases]
Abstract:
In 154 patients with spontaneous subarachnoid hemorrhage owing to a ruptured aneurysm, the way by which the diagnosis was arrived at was checked. The correct diagnosis was missed initially in 52 patients (33.8%) and the subarachnoid hemorrhage was misinterpreted most frequently as systemic infection, brain tumor, disorder of cerebral blood flow or cervical spinal syndrome. The proportion of false diagnosis was especially high in younger patients with an initially less severe illness. Freely practicing physicians without specialist neurological training missed the diagnosis in 33.3%, free practicing specialists for nervous diseases and neurologists in 17.4%, doctors at smaller hospitals in 16.3% and doctors at the Neurologic Division, University Hospital for Nervous Diseases in Homburg/Saar in 6.5%. The time up to correction of a wrong initial diagnosis was up to seven days in 34 patients (65.4%), up to 14 days in 13 patients (25.0%) and between 15 and 27 days in five patients (9.6%).
Insights
Misdiagnosing subarachnoid hemorrhage (SAH) from ruptured aneurysms is common, especially in younger patients. Delayed diagnosis impacts patient outcomes, highlighting the need for improved diagnostic accuracy in emergency settings.
Area of Science:
- Neurology
- Neurosurgery
- Emergency Medicine
Background:
- Spontaneous subarachnoid hemorrhage (SAH) due to ruptured aneurysms is a critical neurological emergency.
- Accurate and timely diagnosis of SAH is crucial for appropriate management and improved patient outcomes.
- Initial misdiagnosis of SAH can lead to significant delays in treatment.
Purpose of the Study:
- To investigate the diagnostic accuracy of subarachnoid hemorrhage (SAH) in patients with ruptured aneurysms.
- To identify factors associated with initial diagnostic errors in SAH.
- To analyze the time delay in correcting misdiagnoses of SAH.
Main Methods:
- Retrospective review of 154 patients diagnosed with spontaneous subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm.
- Analysis of initial diagnostic pathways and recorded misdiagnoses.
- Comparison of diagnostic accuracy based on physician specialty, practice setting, and patient characteristics.
Main Results:
- A significant proportion of patients (33.8%) experienced an initial missed or incorrect diagnosis of SAH.
- Common misdiagnoses included systemic infection, brain tumor, cerebral blood flow disorders, and cervical spinal syndrome.
- Diagnostic errors were more frequent in younger patients and those with initially less severe illness.
- Physicians without specialist neurological training had higher rates of missed SAH diagnoses compared to specialists.
- Delays in correcting misdiagnoses ranged from days to weeks, with 65.4% corrected within seven days.
Conclusions:
- Initial misdiagnosis of subarachnoid hemorrhage (SAH) from ruptured aneurysms is a substantial clinical challenge.
- Factors such as patient age, initial illness severity, and physician expertise influence diagnostic accuracy.
- Improved diagnostic awareness and protocols are essential to reduce delays in SAH management.