Sadighi Alireza, Stanciu Alia, Banciu Mihai, Abedi Vida, Andary Nada El, Holland Neil, Zand Ramin
Department of Neurology, Division of Cerebrovascular Diseases, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Freeman College of Management, Bucknell University, 1 Dent Drive, Lewisburg, PA, 17837-2005, USA.
eNeurologicalSci. 2019 May 16;15:100193. doi: 10.1016/j.ensci.2019.100193. eCollection 2019 Jun.
The goal of this study was to investigate the rate and associated factors of Transient Ischemic Attack (TIA) misdiagnosis.
We retrospectively analyzed consecutive patients with an initial diagnosis of TIA in the emergency department (ED) in a 9-month period. All hospitalized TIA patients were evaluated by a neurologist within 24 h and had at least one hospital discharge follow-up visit within three months. Patients' clinical data and neuroimaging were reviewed. The final diagnosis was independently verified by two stroke neurologists.
Out of 276 patients with the initial diagnosis of TIA, 254 patients (mean age 68.7 ± 15.4 years, 40.9% male, 25.2% final diagnosis of TIA) were included in the analysis. Twenty-four patients (9.4%) were referred to our rapid-access TIA clinic. The rate of TIA misdiagnosis among TIA clinic referred patients was 45.8%. Among the 230 patients in inpatient setting, the rate of TIA misdiagnosis was 60.0%. A hospital discharge diagnosis of TIA was observed in 54.3% of hospitalized patients; however, only 24.8% had the final diagnosis of TIA. Among hospitalized patients, the univariate analysis suggests a significant difference ( < .05) between the two groups (correctly versus misdiagnosed patients) in terms of hospital discharge diagnosis, final diagnosis, history of diabetes mellitus, and coronary artery disease. In regression model hospital discharge diagnosis ( < .001), final diagnosis ( < .001), and diabetes mellitus ( = .018) retained independent association with TIA misdiagnosis.
Our study indicates a high rate of TIA misdiagnosis in the emergency department, hospital, and outpatient clinics.
本研究旨在调查短暂性脑缺血发作（TIA）误诊的发生率及相关因素。
我们回顾性分析了在9个月期间急诊科（ED）初诊为TIA的连续患者。所有住院的TIA患者在24小时内由神经科医生进行评估，并在三个月内至少进行一次出院后随访。回顾了患者的临床资料和神经影像学检查。最终诊断由两名中风神经科医生独立核实。
在276例初诊为TIA的患者中，254例（平均年龄68.7±15.4岁，男性占40.9%，最终诊断为TIA的占25.2%）纳入分析。24例（9.4%）被转诊至我们的快速通道TIA门诊。转诊至TIA门诊的患者中TIA误诊率为45.8%。在230例住院患者中，TIA误诊率为60.0%。54.3%的住院患者出院诊断为TIA；然而，最终诊断为TIA的仅占24.8%。在住院患者中，单因素分析表明两组（正确诊断与误诊患者）在出院诊断、最终诊断、糖尿病史和冠状动脉疾病方面存在显著差异（P<0.05）。在回归模型中，出院诊断（P<0.001）、最终诊断（P<0.001）和糖尿病（P=0.018）与TIA误诊保持独立关联。
我们的研究表明急诊科、医院和门诊诊所中TIA误诊率很高。
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