Beaver Thomas M, Herrbold Francis N, Hess Philip J, Klodell Charles T, Martin Tomas D
Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida 32610-0286, USA.
Ann Thorac Surg. 2005 Jun;79(6):1957-60. doi: 10.1016/j.athoracsur.2004.12.044.
Lack of physician awareness of thoracic aortic disease has received increased media attention. As a referral center for thoracic aortic disease our institutional experience confirms discrepancies between the transferring diagnosis and the actual pathologic diagnosis. A retrospective review was undertaken to identify the incidence and sources for disparate diagnoses.
Medical records from 100 consecutive patients transferred to The University of Florida--Shands Hospital between April 2002 and October 2003 were reviewed. To identify sources for error, the charts of 24 patients with diagnostic discrepancies were examined in detail with attention to outside radiologic reports, level of physician experience, and additional diagnostic testing required.
The transferring diagnosis of 24 patients was different from the final aortic pathologic disease. The most common discrepancies were misclassifications of dissections and aneurysms. Seven patients had either no leak or no dissection. Two patients had misleading "pulsation artifacts" on their computed tomographic scans. In half of the patients diagnostic differences were secondary to initial misinterpretation by the referring radiologist. Seventeen of 24 patients underwent additional diagnostic testing. Misdiagnoses were more common when the referring physician was not a surgeon (15 of 24). The diagnosis of 5 patients was confirmed only in the operating room.
A significant incidence of disparate diagnosis was identified between transferring facilities and our referral center. Discrepancies were secondary to initial radiographic misinterpretation and the complexity of thoracic aortic pathologic disease. Medical schools and continuing medical education programs should place increased emphasis on thoracic aortic disease in their curricula.
医师对胸主动脉疾病认识不足已受到媒体更多关注。作为胸主动脉疾病转诊中心，我们机构的经验证实了转诊诊断与实际病理诊断之间存在差异。进行了一项回顾性研究以确定不同诊断的发生率和来源。
回顾了2002年4月至2003年10月间连续转诊至佛罗里达大学尚德医院的100例患者的病历。为确定错误来源，详细检查了24例诊断有差异患者的病历，关注外部放射学报告、医师经验水平以及所需的额外诊断检查。
24例患者的转诊诊断与最终的主动脉病理疾病不同。最常见的差异是夹层和动脉瘤的错误分类。7例患者既无渗漏也无夹层。2例患者的计算机断层扫描有误导性的“搏动伪影”。一半患者的诊断差异是由于转诊放射科医生最初的错误解读。24例患者中有17例接受了额外的诊断检查。当转诊医生不是外科医生时误诊更常见（24例中有15例）。5例患者的诊断仅在手术室得到证实。
在转诊机构和我们的转诊中心之间发现了不同诊断的显著发生率。差异是由于最初的影像学错误解读和胸主动脉病理疾病的复杂性。医学院校和继续医学教育项目应在其课程中更加重视胸主动脉疾病。
