Misdiagnosis of acute subarachnoid hemorrhage in the era of multimodal diagnostic options

Abstract

ObjectivePatients 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. MethodsThe 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. ResultsOverall 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). ConclusionA straightforward diagnosis of SAH despite diffuse and unspecific symptoms is crucial for the successful treatment of these patients, especially with high grade SAH.