Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study.

IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL
Diagnosis Pub Date : 2024-12-31 DOI:10.1515/dx-2024-0183
Kotaro Kunitomo, Takahiro Tsuji, Yanosuke Kouzaki, Fumitaka Yoshimura, Jyunko Kubosaki, Taro Shimizu
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引用次数: 0

Abstract

Objectives: The purpose of this study was to determine the actual diagnostic status of aseptic meningitis and consider the factors that cause difficulties in its diagnosis.

Methods: This study retrospectively reviewed the medical records of aseptic meningitis treated at our hospital from 2013 to 2022 and compared biometric data to distinguish between timely diagnose and difficult diagnose cases.

Results: This retrospective observational study included 127 patients aged 18 years or older. 66 (52.0 %) were female, with a median age of 35.9±15.9 years. The main symptoms were headache (122, 96.1 %), general malaise (110, 86.6 %), vomiting (79, 62.2 %). The 127 patients were classified into two groups: A timely diagnosis group diagnosed within 6 days of symptom onset, and a difficult diagnosis group diagnosed within 7 days or longer. There were significant differences between the two groups in the proportion of patients with a history of antimicrobial treatment and fever above 38 °C, and in the positive rates of neck stiffness and jolt accentuation of headache (JAH). The total number of hospitals involved in the process of diagnosis was significantly higher in the difficult diagnosis group and the length of inpatient stay was significantly longer. Multivariate analysis revealed significant differences in neck stiffness, JAH, and prior antibacterial therapy.

Conclusions: Atypical cases, such as neck stiffness and JAH negativity, may make the diagnosis difficult. Clinicians should be aware of this atypical presentation of aseptic meningitis.

影响无菌性脑膜炎诊断困难的因素:一项回顾性观察研究。
目的:本研究的目的是确定无菌性脑膜炎的实际诊断状况,并考虑导致其诊断困难的因素。方法:回顾性分析我院2013年至2022年收治的无菌性脑膜炎病例,对比生物特征数据,区分诊断及时与诊断难的病例。结果:本回顾性观察性研究纳入了127例18岁及以上的患者。女性66例(52.0 %),中位年龄35.9±15.9岁。主要症状为头痛(122例,96.1 %)、全身不适(110例,86.6 %)、呕吐(79例,62.2 %)。将127例患者分为两组:及时诊断组在症状出现后6天内确诊,难诊断组在症状出现后7天及以上确诊。两组患者在抗菌药物治疗史和发烧高于38 °C的比例,以及颈部僵硬和震动加重头痛(JAH)的阳性率方面存在显著差异。诊断困难组参与诊断过程的医院总数显著高于诊断困难组,住院时间显著长于诊断困难组。多变量分析显示颈部僵硬、JAH和既往抗菌治疗有显著差异。结论:非典型病例,如颈部僵硬和JAH阴性,可能使诊断困难。临床医生应注意无菌性脑膜炎的这种非典型表现。
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来源期刊
Diagnosis
Diagnosis MEDICINE, GENERAL & INTERNAL-
CiteScore
7.20
自引率
5.70%
发文量
41
期刊介绍: Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.  Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
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