Possible Diagnostic Error in Cervical Artery Dissection: Analysis of STOP-CAD Study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Bakradze Ekaterina, Shu Liqi, Yaghi Shadi, Tran Thanh Lam Ngoc, Crandal Ross Curtiss, Lester Evan, Mandel Daniel M, Siegler James Ernest, Penckofer Mary, Liberman Ava Leigh, Field Thalia S, Khan Farhan, Kam Wayneho, Mac Grory Brian, Saleh Velez Faddi G, Henninger Nils, Elangovan Cheran, Krishnaiah Balaji, Gandhi Preet, Shahripour Reza Bavarsad, Ghannam Malik, Heldner Mirjam Rachel, Antonenko Kateryna, Rothstein Aaron, Leker Ronen R, Metanis Issa, Samaniego Edgar, Romoli Michele, Zedde Marialuisa, Pascarella Rosario, Nguyen Thanh N, Klein Piers, Khasiyev Farid, Khazaal Ossama, Almajali Mohammad, Zubair Adeel S, Elnazeir Marwa, Marto João Pedro, Nehme Ahmad, Giles James Anthony, Engelter Stefan T, Stretz Christoph, Salehi Omran Setareh
Аннотация
METHODS: We conducted a secondary analysis of the STOP-CAD (Antithrombotic Therapy for Stroke Prevention in Cervical Artery Dissection) study, which is a multicenter international study of adult patients admitted with CeAD. Possible diagnostic error was defined as the presence of CeAD symptoms within 30 days before the index CeAD diagnosis. The comparison group included patients diagnosed on their first medical encounter. Multivariable regression was used to identify factors associated with possible diagnostic error. Primary and secondary outcomes included ischemic stroke, death, and modified Rankin Scale score <2.
RESULTS: Of 4012 patients (mean age 47.5 years, 44.6% female), 663 (16.5%) experienced possible diagnostic error. Among these, 224 (33.8%) reported to have ischemic stroke before CeAD diagnosis. Patients with possible diagnostic error were younger (odds ratio [OR], 0.89, P<0.001), more likely to have a history of migraines (OR, 1.35, P=0.007), and more likely to present with headaches (OR, 1.43, P<0.001), but less likely to show focal neurologic signs (OR, 0.68, P<0.001). There was no significant difference between groups in ischemic stroke after diagnosis (adjusted OR, 0.96, P=0.86), 90-day modified Rankin Scale score <2 (adjusted OR, 1.04, P=0.80), or death (adjusted OR, 0.58, P=0.34).
CONCLUSIONS: One in 6 patients with CeAD experienced a possible diagnostic error, particularly those who were younger, had migraines, or presented with headaches and nonfocal symptoms.