Common cold is the most frequent cause for misdiagnosing aneurysmal SAH

Abstract

Background: Misdiagnosis of subarachnoid hemorrhage has been hypothesized to affect outcomes. We studied patients with SAH who were admitted to our hospital to identify ways to prevent misdiagnosis. Methods: A total of 709 patients with subarachnoid hemorrhage were admitted to the Department of Neurosurgery of our hospital from January 2003 through December 2014. Fifty patients (7.05%) received a misdiagnosis. The patients were divided into a misdiagnosis group and a correct diagnosis group and compared. We examined the clinical features associated with misdiagnoses in the 41 patients with a misdiagnosis. Results: There were statistically significant differences between the misdiagnosis group and correct diagnosis group in age (p = 0.017), status at onset (p = 0.020), symptoms (p = 0.000402), period from symptom onset (p = 1.03 × 10−5), transportation (p = 4.57 × 10−27), Hunt & Kosnik grade (p = 3.23 × 10−48), WFNS grade (p = 2.22 × 10−25), type of medical institution (p = 2.17 × 10−39), bleeding source (p = 0.041), and the modified Rankin Scale at discharge (p = 2.24 × 10−5). Conclusions: Subarachnoid hemorrhage was misdiagnosed as a common cold in younger patients in whom headache suddenly developed at rest, but symptoms were mild, and the patient was brought to a general practitioner at a clinic by means other than an ambulance on the day after onset or subsequently. Misdiagnosis can be prevented by suspecting subarachnoid hemorrhage and performing imaging examinations; obtaining a detailed medical history is therefore essential. Keywords: Subarachnoid hemorrhage, Misdiagnosis, Re-bleeding