误诊疾病数据库2004-2013年单病种误诊文献研究：致惊厥杀鼠剂中毒

A Study on Misdiagnosis Literature of Single Disease of Chinese Misdiagnosed Disease Database: Convulsive Rodenticide Poisoning

致惊厥杀鼠剂是常见的急性杀鼠剂,毒性强。致惊厥杀鼠剂中毒病情发展迅速,临床表现无特异性,病死率高,虽然临床诊疗技术快速发展,但本病误诊率仍较高。2004—2013年发表在中文医学期刊并经遴选纳入误诊疾病数据库的致惊厥杀鼠剂中毒文献共18篇,误诊病例119例,涉及误诊率文献7篇387例,误诊例数90例,误诊率23.26%;误诊范围涉及13种疾病,其中前4位误诊疾病是癫痫、中枢神经系统感染、高热惊厥、氟乙酰胺中毒,占误诊疾病总例次的84.00%。首位误诊原因为接诊医师问诊及体格检查不细致。119例误诊病例中,98例(82.35%)未因误诊误治造成不良后果,14例(11.76%)导致死亡。提示临床医师应提高对致惊厥杀鼠剂中毒的认识,对不明原因抽搐患者应考虑本病可能,认真细致问诊及体格检查,及时行毒物检测并加强鉴别诊断。

Convulsant rodenticides are common acute rodenticides with high toxicity. Convulsive rodentieide poisoning are characterized by rapid progression, non-specific clinical features and high mortality. Although clinical diagnosis technolo- gies have been rapidly developed, the misdiagnosis rate of the disease is still high. There are 18 articles with 119 misdiagnosis cases about convulsive rodenticide poisoning and 7 articles of 387 cases with 90 misdiagnosis cases （ mlsdiagnosis rate 23.26% ）. The articles were selected from Chinese medical journals during 2004-2013. The misdiagnosed cases covered 13 diseases, the top four misdiagnosed diseases are： epilepsia, central nervous system infections, hyperpyretic convulsion, viral encephalitis and fluoroacetamide poisoning, accounting for 84.00% of the total number of misdiagnosed cases. The top com- mon misdiagnosis cause is careless interrogation and physical examination by physicians. Among 119 misdiagnosis cases, there are 98 cases （82.35%） with adverse consequences and 14 cases （11.76% ） of death due to misdiagnosis. Clinicians should deepen the understanding of convulsant rodenticide poisoning. When patients present unexplained seizures, the possibility of convulsant rodenticide poisoning should be considered. To reduce the misdiagnosis rate, careful inquiry and physical examina- tion should be taken seriously and poison detection should be done as soon as possible.