偏头痛延迟诊断的相关因素：一项基于医院的横断面研究。
Factors associated with delayed diagnosis of migraine: A hospital-based cross-sectional study.
作者信息
Rai Nirendra Kumar, Bitswa Ritwa, Singh Ruchi, Pakhre Abhijit P, Parauha Daya Shankar
机构信息
Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
出版信息
J Family Med Prim Care. 2019 Jun;8(6):1925-1930. doi: 10.4103/jfmpc.jfmpc_376_19.
CONTEXT
Migraine is common debilitating disorders, affecting 10 to 20% of the world's population. However, proper diagnosis is delayed due to many factors.
AIMS
To determine various factors associated with delayed diagnosis of migraine.
SETTINGS AND DESIGN
Hospital-based cross-sectional study.
MATERIALS AND METHODS
Patients attending Neurology OPD of AIIMS Bhopal and satisfying diagnostic criteria of the International Headache Society (ICHD-3β) for migraine were selected for study. MIDAS, MINI, and ROME-III were used. First diagnosis was considered as "Appropriate" if patients were previously diagnosed as "migraine" or getting treatment for it; otherwise labeled as "Inappropriate."
STATISTICAL ANALYSIS
Associations were tested by Chi-square, -test, or Mann-Whitney test. Logistic regression analysis was used for identifying independent factors associated with inappropriate diagnosis.
RESULTS
Hundred patients (female = 77) of migraine were included. Mean age (SD) was 32.42 (10.74). Diagnosis was "inappropriate" in 65 patients. Number of inappropriate diagnosis/appropriate diagnosis was 10/40 (25%) by neurologists; 35/39 (89.3%) by physicians; 18/18 (100%) by ophthalmologists. Factors associated with "Inappropriate Diagnosis" were "Neurologist vs Other Doctors" {10 (25%) vs 55 (91.7%), < 0.001}; throbbing vs other types of headache {51 (60.7%) vs 14 (87%), = 0.047}; and temporal vs other sites {9 (42.9%) vs 56 (70.9%), = 0.017}. Patients with "Inappropriate Diagnosis" had to expend more money {7000 (4,500; 12,500) vs 4000 (1000, 6000), < 0.01; median (interquartile range) all in INR}. Other clinical parameters including vertigo, cervical pain, anxiety, depression, and functional gastrointestinal symptoms were not associated with delayed diagnosis.
CONCLUSION
Delayed diagnosis and misdiagnosis is very frequent in migraine, leading to financial burden to patients. Management of common disorders like migraine should be addressed in undergraduate medical teaching curriculum.
背景
偏头痛是常见的使人衰弱的疾病，影响着全球10%至20%的人口。然而，由于多种因素，正确诊断被延迟。
目的
确定与偏头痛延迟诊断相关的各种因素。
设置与设计
基于医院的横断面研究。
材料与方法
选择就诊于博帕尔全印医学科学研究所神经科门诊且符合国际头痛协会（ICHD-3β）偏头痛诊断标准的患者进行研究。使用了偏头痛残疾评定量表（MIDAS）、简明国际神经精神访谈（MINI）和罗马III标准。如果患者之前被诊断为“偏头痛”或正在接受相关治疗，则首次诊断被视为“恰当”；否则标记为“不恰当”。
统计分析
通过卡方检验、t检验或曼-惠特尼检验来检验相关性。使用逻辑回归分析来确定与不恰当诊断相关的独立因素。
结果
纳入了100例偏头痛患者（女性77例）。平均年龄（标准差）为32.42（10.74）。65例患者的诊断为“不恰当”。神经科医生诊断不恰当/恰当的比例为10/40（25%）；内科医生为35/39（89.3%）；眼科医生为18/18（100%）。与“不恰当诊断”相关的因素有“神经科医生与其他医生”{10例（25%）对55例（91.7%），P<0.001}；搏动性头痛与其他类型头痛{51例（60.7%）对14例（87%），P=0.047}；以及颞部头痛与其他部位头痛{9例（42.9%）对56例（70.9%），P=0.017}。“诊断不恰当”的患者花费更多{7000（4500；12500）对4000（1000，6000），P<0.01；中位数（四分位间距），均为印度卢比}。其他临床参数，包括眩晕、颈部疼痛、焦虑、抑郁和功能性胃肠道症状，与延迟诊断无关。
结论
偏头痛的延迟诊断和误诊非常常见，给患者带来经济负担。本科医学教学课程应涵盖偏头痛等常见疾病的管理。
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