隐匿性巩膜裂伤在各级医院的漏误诊危险度分析

Risk of misdiagnosis of occult scleral rupture in different levels of healthcare facilities

目的分析隐匿性巩膜裂伤在各级医院的漏误诊危险度,为临床上提高各级医院诊疗水平提供理论依据。方法回顾性分析近5年来我院收治并经手术探查证实为隐匿性巩膜裂伤的患者资料,通过χ2检验和Ridit分析研究了30例(30只眼)隐匿性巩膜裂伤患者的就诊情况、漏误诊率及漏误诊危险度与各级医院的相关性。结果 30例患者从受伤到最后确诊共就诊、住院87次,首诊时以县级以下医疗机构最多,次诊时以县级医院最多,三诊、四诊均以省市大型三甲教学医院最高。县级以下医院漏误诊率及漏误诊危险度均最高,与标准组差异有统计学意义(P<0.05)。省市大型三甲教学医院漏误诊率及漏误诊危险度最低,与标准组差异有统计学意义(P<0.05)。其他级别医院依次介于二者之间。结论隐匿性巩膜裂伤是一类在临床上容易出现漏误诊的特殊眼球破裂伤类型,各级医院均有不同程度的漏误诊危险,因此应提高警惕,加强相关资源的合理配备和医师的临床诊治能力的提高以减少漏误诊发生。

Objective To investigate the risk of misdiagnosis of occult scleral rupture that presented to healthcare facilities of different levels , and to provide strategies for the improvement of care quality .Methods Thirty cases （ 30 eyes） of occult scleral rupture that were diagnosed and treated in our hospital in the past 5 years were reviewed .Scleral ruptures were confirmed by surgery .Number of hospital visits , misdiagnosis rate , and their relationships to hospital levels were analyzed with chi-square tests and Ridit analysis .Results There were totally 87 hospital visits among 30 patients. Most patients seek medical attention at sub-county hospitals initially .Subsequent hospital visits occurred at county hospi-tals, followed by teaching hospitals and tertiary medical centers .Sub-county hospitals contributed most to the misdiagnosis rate of occult scleral rupture （ P 〈0.05）, while tertiary medical centers and teaching hospitals have the lowest misdiagno-sis rate （ P 〈0.05）.Conclusion Occult scleral rupture is a special type of global injury that can be easily misdiag-nosed.Misdiagnosis could happen in all levels of healthcare facilities .Physicians should maintain a high level of suspi-cions, and administrative organizations should provide physicians with more resources and trainings in order to facilitate proper diagnosis and treatment .