最初的错误诊断和下大脑底下出血后的结果
Robert G Kowalski1, Jan Claassen, Kurt T Kreiter
1Division of Stroke and Critical Care Neurology, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
JAMA
|February 19, 2004
概括
动脉瘤下arachnoid出血 (SAH) 的初始错误诊断会影响患者的治疗结果. 错误诊断的SAH患者,特别是最初健康的患者,面临着更差的生活质量和增加的死亡率.
科学领域:
- 神经学 神经学
- 神经外科 神经外科
- 紧急医疗 紧急医疗
背景情况:
- 动脉瘤下arachnoid出血 (SAH) 需要紧急治疗,以减少死亡率和发病率.
- 及时诊断对于有效的SAH管理和改善患者结果至关重要.
研究的目的:
- 为了调查初始误诊和患者在动脉瘤下arachnoid出血 (SAH) 后的结果之间的关联.
- 确定导致SAH误诊的因素及其对功能状态和生活质量的影响.
主要方法:
- 分析了入住第三级医院的482名SAH患者的初始队列.
- 错误诊断被定义为在初次医疗接触时未能诊断SAH.
- 功能性结果使用修改后的兰金尺度和3个月和12个月使用疾病影响概况来评估生活质量.
主要成果:
- 12%的SAH患者 (56/482) 最初被误诊,偏头痛或紧张性头痛是最常见的错误诊断.
- 无法获得计算机断层扫描 (CT) 扫描是主要的诊断错误 (73%).
- 错误诊断与正常精神状态,较小的出血量有关,并且与12个月后更差的生活质量和增加的死亡率/严重残疾有关,特别是在具有正常精神状态的患者中.
结论:
- 在12%的SAH病例中,初始错误诊断,特别是在精神状况正常的患者中,显著增加了死亡率和发病率.
- 建议在轻度,SAH-暗示症状的患者进行CT扫描的低门,以减少误诊率.
- 早期和准确的SAH诊断对于改善患者的治疗结果和减少长期残疾至关重要.
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