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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Initially Missed or Delayed Diagnosis of Subarachnoid Hemorrhage: A Nationwide Survey of Contributing Factors and Outcomes in Japan
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Initially Missed or Delayed Diagnosis of Subarachnoid Hemorrhage: A Nationwide Survey of Contributing Factors and Outcomes in Japan

机译：最初错过或延迟抑制蛛网膜下腔出血：日本贡献因素和结果的全国范围内

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Background: Subarachnoid hemorrhage (SAH) remains a significant cause of mortality in Japan. The Japan Stroke Society set out to conduct a nationwide survey to identify contributing factors and outcomes of SAH misdiagnosis. Methods: We initially surveyed 737 training institutes and 1259 departments in Japan between April 2012 and March 2014 for the presence of misdiagnosed SAH. Clinical information was then sought from respondents with a positive misdiagnosis. Information on 579 misdiagnosed cases was collected. Results: Most initial misdiagnoses occurred in nonteaching hospitals (72%). Of those presenting with headache, 55% did not undergo a computed tomography (CT) scan. In addition, SAH was missed in the patients who underwent CT scans. The clinically diagnosed rerupture rate was 27%. Mortality among all cases was 11%. Institutes achieving a final diagnosis were staffed by neurologists or neurosurgeons. Multivariate logistic regression analysis indicated that age (= 65), consciousness level (Japan Coma Scale score at correct diagnosis), rerupture of an aneurysm, and no treatment by clipping or coiling were significantly associated with poor clinical outcome. Conclusions: The prognosis of misdiagnosis of SAH is severe. Neuroradiological assessment and correct diagnosis can prevent SAH misdiagnosis. When there is a possible diagnosis of SAH, consultation with a specialist is important.
机译：背景：蛛网膜下腔出血（SAH）仍然是日本死亡率的重要原因。日本中风社会出发了一个全国范围内的调查，以确定SAH误诊的贡献因素和结果。方法：我们最初在2012年4月和2014年间日本调查了737次培训机构和1259个部门，误认为是误诊的SAH。然后从受访者寻求临床信息，患有阳性误诊。收集有关579个误诊案件的信息。结果：大多数初始误诊发生在未换行医院（72％）。在患有头痛的人的情况下，55％没有经过计算的断层扫描（CT）扫描。此外，在接受CT扫描的患者中错过了SAH。临床诊断的破裂率为27％。所有病例中的死亡率为11％。实现最终诊断的机构由神经系统或神经外科医生组成。多变量逻辑回归分析表明，年龄（＆ = 65），意识水平（日本昏迷评分在正确的诊断中），动脉瘤的破裂，并且通过剪切或卷曲的不治疗与临床结果不良。结论：Sah误诊的预后严重。神经加理学评估和正确的诊断可以预防萨赫误报。当有可能的SAH诊断时，与专家的咨询很重要。

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