初療機関でくも膜下出血と診断できなかった頭痛患者に関する検討

抄録

We examined the clinical course of 32 patients with subarachnoid hemorrhage (SAH) in which the definitive diagnosis was delayed owing to an incorrect diagnosis during the initial hospital visit, although they presented with a headache, which was their chief complaint.
More than 80% of the patients had visited the hospital by the next day after symptom onset (21 patients visited on the same day; 6, 1 day later; and 5, 2 or more days after). All the patients visited the hospital on foot. Fourteen patients received an unspecified diagnosis (the most frequent diagnosis), 6 had a common cold, 2 had acute gastroenteritis, and 2 had a cervical spine sprain. Eleven patients initially visited medical institutions that had computed tomography (CT) scanners, among whom only 3 underwent CT, which showed mild SAH that went unnoticed by the attending physicians at that time. Eighteen patients visited the hospital 2 times, 10 visited 3 times, and 4 visited 5 times until a definitive diagnosis of SAH was made.
For walk-in patients, SAH was infrequently suspected, and the rate of CT scanning was low, even in those with a headache as the chief complaint.
In patients who revisit hospitals with the same complaint of a headache and show no improvement, SAH should be first ruled out during the definitive diagnosis.