Alexandros Doukas1, Harald Barth2, K Athanasios Petridis3, Maximilian Mehdorn2, Christian von der Brelie4. 1. Clinic of Neurosurgery, University Clinics Schleswig, Holstein Campus Kiel Arnold-Heller str. 3, 24105, Germany. Electronic address: axlpam@gmail.com. 2. Clinic of Neurosurgery, University Clinics Schleswig, Holstein Campus Kiel Arnold-Heller str. 3, 24105, Germany. 3. Clinic of Neurosurgery, University Clinic Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany. 4. Clinic of Neurosurgery, University Clinic Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
Abstract
OBJECTIVE: Patients suffering from aneurysmatic Subarachnoid Hemorrhage (SAH) may present with a variety of symptoms. The aim of this study is to evaluate the spectrum of misdiagnoses and to analyze the significance of delay of correct diagnosis on the clinical outcome. METHODS: The data was collected prospectively from 2003 to 2013. Patients diagnosed with disease different from aneurysmal SAH by the initially treating physician, and admitted to our department with a delay of at least 24 h after the beginning of the symptoms, were included in this study. We analyzed the various diagnoses that were ascertained instead of SAH and which medical specialty had provided them. RESULTS: Overall 704 patients were treated with acute SAH. The inclusion criteria were matched in 76 patients (13.7%). Eleven specialties were involved in the initial patients' treatment. The time interval between initial symptoms and neurosurgical admission varied enormously. Statistically, higher Hunt & Hess score did not lead to an earlier diagnosis (p = 0.56) nor did localisation of the aneurysm (p = 0.75). Lower Fisher score was led to delayed diagnosis (p = 0.02). Delay of diagnosis was not significantly associated with the outcome (p = 0.08) whereas Hunt & Hess grade on admission was a strong predictor for bad outcome (p = 0.00001) as was cerebral vasospasm on the first angiogram (p < 0.05). CONCLUSION: A straightforward diagnosis of SAH despite diffuse and unspecific symptoms is crucial for the successful treatment of these patients, especially with high grade SAH.
OBJECTIVE:Patients suffering from aneurysmatic Subarachnoid Hemorrhage (SAH) may present with a variety of symptoms. The aim of this study is to evaluate the spectrum of misdiagnoses and to analyze the significance of delay of correct diagnosis on the clinical outcome. METHODS: The data was collected prospectively from 2003 to 2013. Patients diagnosed with disease different from aneurysmalSAH by the initially treating physician, and admitted to our department with a delay of at least 24 h after the beginning of the symptoms, were included in this study. We analyzed the various diagnoses that were ascertained instead of SAH and which medical specialty had provided them. RESULTS: Overall 704 patients were treated with acute SAH. The inclusion criteria were matched in 76 patients (13.7%). Eleven specialties were involved in the initial patients' treatment. The time interval between initial symptoms and neurosurgical admission varied enormously. Statistically, higher Hunt & Hess score did not lead to an earlier diagnosis (p = 0.56) nor did localisation of the aneurysm (p = 0.75). Lower Fisher score was led to delayed diagnosis (p = 0.02). Delay of diagnosis was not significantly associated with the outcome (p = 0.08) whereas Hunt & Hess grade on admission was a strong predictor for bad outcome (p = 0.00001) as was cerebral vasospasm on the first angiogram (p < 0.05). CONCLUSION: A straightforward diagnosis of SAH despite diffuse and unspecific symptoms is crucial for the successful treatment of these patients, especially with high grade SAH.