Misdiagnosis Worsens Prognosis in Subarachnoid Hemorrhage With Good Hunt and Hess Score

• DOI: 10.1161/strokeaha.119.025520
• Publication Date: 2019-10-10T09:00:56Z
• Authors: Angel Ois; Elio Vivas; Georgina Figueras...; Leopoldo Guimaraens; Elisa Cuadrado-Godia; Carla Avellaneda; Bernat Bertran-Re...; Ana Rodríguez-Cam...; Maria-Pilar Gracia; Gloria Villalba; Jesus Saldaña; Jaume Capellades; Juan-Luis Fernánd...; Jaume Roquer
• Keywords: Stroke

Background and Purpose- Our aim was to describe variables associated with initial misdiagnosis of subarachnoid hemorrhage (SAH). We also analyzed the relationship poor outcome complications in good Hunt Hess (HH) cases. Methods- In a prospective cohort 401 patients SAH, defined as failure correctly identify, at first physician contact, subsequently documented SAH; this meant no urgent radiological study lumbar puncture performed. Poor modified Rankin Scale score 3 6 3-month follow-up. recorded age, sex, hypertension, diabetes mellitus, current smoking, previous antithrombotic treatment, HH severity, presence aneurysm, therapeutic procedure, hydrocephalus, delayed cerebral ischemia (DCI), rebleeding, procedure-related complications. Results- Misdiagnosis confirmed 104/401 (25.9%) patients, who had longer time-to-admission hospital. less clinical compared correct diagnosis; 2 groups did not differ age or cardiovascular risk factor profile. registered 167/401 (41.6%). Age, misdiagnosis, greater severity were independent predictors outcome. 236 (58.8% cohort) 1-2, univariate multivariate analysis, respectively (odds ratio=3.89; 95% CI, 1.89-8.01). Delayed ratio=2.47; 1.2-5.09) ratio=2.27; 1.07-4.82) independently misdiagnosis. Conclusions- is an unresolved problem it missed opportunity for 1-2. The partially explained by higher misdiagnosed patients. There need improve diagnostic strategy reporting only headache (HH 1-2) after SAH.