Análisis del error diagnóstico en pacientes con hemorragia subaraconidea aneurismática en Uruguay: presentación de un estudio prospectivo multicéntrico

Abstract

Introduction: Subarachnoid hemorrhage (SAH) represents only 3%-5% of all cerebrovascular accidents (CVA). The objective of this work is to analyze the diagnostic error in Uruguay and its implications in the prognosis. Materials and Methods: This is a prospective and multicenter study, including all patients older than 18 years, who presented spontaneous aneurysmal SAH in Uruguay between November 1,2019 and July 31,2020. A single data collection sheet was made, analyzing relevant variables for the pathology under study. Diagnostic error was defined as the impossibility of recognizing this pathology in the initial and subsequent medical consultations, granting discharge to these patients. This was subdivided into two: 1) patients with only one consultation, and 2) patients with two or more consultations. The delay in diagnosis and the period of the pandemic in which they were treated were also analyzed. The level of significance used in the tests was 5%. The research was previously approved by all institutional Ethics Committees, as well as analyzed by the National Research Ethics Commission (CNEI), as it is a multicenter study. Results: The total number of patients analyzed was 211. Regarding the clinical presentation of SAH, headache and vomiting were the most frequent (83% and 46%, respectively). A diagnostic error was found in 24% of the patients. Regarding the analysis of the complications that could be modified or increased by the diagnostic error, it was shown that vasospasm had a statistically significant link in relation to the diagnostic error. Conclusions: Of the complications attributable to a diagnostic error, vasospasm was the only one that was correlated with it