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(Stroke. 2007;38:1129.)
© 2007 American Heart Association, Inc.

Editorial

Diagnosis of Subarachnoid Hemorrhage

Are We Doing Better?

Jonathan A. Edlow, MD

From the Beth Israel Deaconess Medical Center, Emergency Medicine, Boston, Mass.

Correspondence to Jonathan A. Edlow, MD, Beth Israel Deaconess Medical Center, Emergency Medicine, 1 Deaconess Rd, Boston, MA 02215. E-mail jedlow@bidmc.harvard.edu

Key Words: aneurysm • aneurysms • cerebrovascular disease • diagnostic methods • misdiagnosis • subarachnoid hemorrhage

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 1216–1221.

When I began practicing emergency medicine 25 years ago, a stroke patient’s arrival to the emergency department (ED) did not elicit the frenetic burst of activity that it currently does. For that matter, neither did the arrival of a heart attack patient—until the approval of thrombolytic treatment for myocardial infarction. For patients with cerebrovascular emergencies, new treatment options such as thrombolytics and pro-coagulants demand earlier and accurate diagnosis.

The shift to early aneurysm obliteration for aneurysmal subarachnoid hemorrhage (SAH) makes its early and accurate diagnosis equally important. Forty percent of patients with SAH die, and 30% of survivors are left with significant neurological disability¹; however, nearly half of all patients present in good clinical condition.² In this group, early treatment prevents rebleeding and results in excellent outcomes. Unfortunately, numerous investigations over several continents and decades document that physicians miss the diagnosis of SAH with a disappointing frequency.^3–10

In this issue of Stroke,¹¹ Vermeulen and Schull present data suggesting that Canadian emergency physicians miss the diagnosis of SAH in 5.4% of cases. Although this may seem like a high miss rate, it is much lower than what has been previously reported.

A 2000 review of the subject showed that SAH was misdiagnosed in 32% of 685 cases pooled from 4 large studies.¹² The average time delay was 6 days. Most misdiagnosed patients present in good clinical condition but their condition often deteriorates by the time of the second visit. Analysis suggests 3 recurring, . . . [Full Text of this Article]

Related Article:

Missed Diagnosis of Subarachnoid Hemorrhage in the Emergency Department

Marian J. Vermeulen and Michael J. Schull
Stroke 2007 38: 1216-1221. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				J. A. Edlow, R. E. Rothman, and W. G. Barsan What Do We Really Know About Neurological Misdiagnosis in the Emergency Department? Mayo Clin. Proc., February 1, 2008; 83(2): 253 - 254. [Full Text] [PDF]