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Initial misdiagnosis of aneurysmal subarachnoid hemorrhage: associating factors and its prognosis

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Predicting the fate of patients who are given a misdiagnosis of aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. The purpose was to examine factors associated with initial misdiagnosis of aSAH and to investigate the impact of initial misdiagnosis of aSAH on clinical outcomes.

Methods

Between January 2007 and December 2015, medical records and radiographic data for 3118 consecutive patients with aSAH were reviewed. There were 33 patients who had been documented with an initial misdiagnosis of aSAH, and all met the following criteria: (1) failure to correctly identify aSAH upon initial presentation to health care professionals; and 2) subsequently documented aSAH after the initial misdiagnosis. After applying exclusion criteria, remaining 2898 patients were included in the control group.

Results

The most common cause of the misdiagnosis is failure to detect aSAH on the initial radiographic imaging. Misdiagnosis group showed lower initial Glasgow Coma Scale, better Hunt-Hess grade, and lower Fisher’s grade. Logistic regression analysis showed that initial HH grade (OR, 0.216; p = 0.014), initial Fisher’s grade (OR, 0.732; p = 0.036), and hospital type during initial contact (OR, 2.266; p = 0.042) were independently associated with misdiagnosis of aSAH.

Conclusions

Patients with initially good HH grade, lower Fisher’s grade, and visiting non-teaching hospital for initial contact were at risk of being misdiagnosed. Misdiagnosis of aSAH in patients with initial good HH grade did affect clinical outcomes negatively. The rebleeding rate was not significantly different between two groups. However, the mortality rate due to rebleeding was higher in MisDx group than in non-MisDx group.

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Authors and Affiliations

  1. Department of Neurosurgery, Inha University College of Medicine, Incheon, Republic of Korea

    Se-yang Oh & Yu Shik Shim

  2. Department of Neurosurgery, Ajou University College of Medicine, Suwon, Republic of Korea

    Yong Cheol Lim

  3. Department of Neurosurgery, Konyang College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea

    Jihye Song

  4. Department of Neurosurgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea

    Sang Kyu Park

  5. Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Republic of Korea

    Sook Young Sim

  6. Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Republic of Korea

    Myeong Jin Kim

  7. Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Yong Sam Shin

  8. Department of Neurosurgery, Severance Hospital, Seoul, Republic of Korea

    Joonho Chung

  9. Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea

    Joonho Chung

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  1. Se-yang Oh
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Correspondence to Joonho Chung.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study formal consent is not required.

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Oh, Sy., Lim, Y.C., Shim, Y.S. et al. Initial misdiagnosis of aneurysmal subarachnoid hemorrhage: associating factors and its prognosis. Acta Neurochir 160, 1105–1113 (2018). https://doi.org/10.1007/s00701-018-3552-6

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  • DOI: https://doi.org/10.1007/s00701-018-3552-6

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