误诊疾病数据库2005—2012年单病种误诊文献研究:蛛网膜下腔出血

A Study on Misdiagnosis Literature of Single Disease of Chinese Misdiagnosed Disease Database: Subarachnoid Hemorrhage

蛛网膜下腔出血(subarachnoid hemorrhage,SAH)是临床常见脑血管疾病。虽然临床诊疗技术不断发展,但本病误诊率仍居高不下。2005—2012年发表在中文医学期刊并经遴选纳入误诊疾病数据库的SAH文献共118篇,纳入误诊病例2085例,平均误诊率20.43%;误诊范围涉及80种疾病,其中前3位误诊疾病为后循环缺血、各种头痛和高血压病。对误诊疾病数据库中近3000种疾病的误诊范围检索发现,共29种疾病易误诊为SAH,居前3位的是颅内静脉窦血栓形成、低颅压综合征和脑出血。2085例误诊病例首位误诊原因为接诊医师经验不足,缺乏对该病的认识,占总误诊原因的24.23%,其中133例(6.38%)造成1级误诊后果(死亡或遗留后遗症),21例(1.01%)造成2级误诊后果(因误诊而导致病程迁延或导致不必要的手术),1225例(58.75%)造成3级误诊后果(未因误诊造成明显不良后果),706例(33.86%)失访或文献未交代预后。提示临床医师应加强对SAH的认识,详细询问病史及细致全面查体,及时合理选择腰椎穿刺脑脊液、头颅CT检查,早诊断并给予有效的针对性治疗,降低病死率。

Subarachnoid hemorrhage（ SAH） is a common type of cerebrovascular disease. Although clinically diagnostic technique develops quickly,the misdiagnosis rate of SAH is still high. 118 literatures of misdiagnosis SAH were selected from enrolled misdiagnosis disease database,published in Chinese medical journals during 2005 to 2012. The enrolled misdiagnosed cases were 2085 patients and the average misdiagnosis rate was 20. 43%. The misdiagnosis diseases involved 80 kinds of diseases. Among them,the most misdiagnosed cases were posterior circulation ischemia,headache and hypertension.29 kinds of diseases from 162 literatures including 394 patients were found to be frequently misdiagnosed as SAH after searching full disease database. The top three diseases were venous sinus thrombosis,intracranial hypotension syndrome and cerebral hemorrhage. In the 2085 misdiagnosed cases,the leading misdiagnosis cause was lack of clinical experience and lack of awareness of the disease on the physicians＇ part,accounting for 24. 23%,including 133 cases（ 6. 38%） developed grade Ⅰmisdiagnosis result（ death or obvious sequela）,21 cases（ 1. 01%） grade Ⅱ misdiagnosis result（ prolonged disease course or unnecessary surgery）,1225 cases（ 58. 75%） grade Ⅲ misdiagnosis results（ no obvious adverse Sequa）,and 706 cases（ 33. 86%） were unclear due to lost follow up or unexplained prognosis of literatures. The results imply that clinical physicians should enrich the knowledge of SAH. The detailed history and careful physical examination,timely and reasonable lumbar puncture,and CT examination are essential for early diagnosis and treatment so as to reduce mortality rate.