Misdiagnosis of Acute Limb Ischemia from Non-Vascular Specialists Results in a Delayed Presentation and Negatively Affects Patients' Outcomes.

Q1 Medicine

Medical sciences (Basel, Switzerland) Pub Date : 2025-02-20 DOI:10.3390/medsci13010021

Michalis Pesmatzoglou, Stella Lioudaki, Nikolaos Kontopodis, Ifigeneia Tzartzalou, Konstantinos Litinas, George Tzouliadakis, Christos V Ioannou

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Abstract

Background/objectives: Acute Limb Ischemia (ALI) is a vascular emergency which is accompanied by a significant risk of limb loss or even death. Rapid restoration of arterial perfusion using surgical and/or endovascular techniques is crucial for limb salvage. Undeniably, an accurate and prompt diagnosis is the first step to improve patient prognosis. The typical clinical presentation is not always present and the variety of symptoms may result in non-vascular specialists missing the diagnosis.

Methods: In this single-center retrospective descriptive study, we reviewed all patients hospitalized between January 2018 and January 2024 for ALI. Patients who were initially misdiagnosed, causing a delayed diagnosis > 24 h, and who therefore did not receive timely treatment, were identified. Moreover, patients with a timely diagnosis of ALI who were treated in our institution during the same time period were collected.

Results: Among 280 ALI patients, 14 were initially misdiagnosed. The median time from initial symptoms to definite diagnosis was 38.8 days (range 1.5-365). Several specialties such as orthopedic surgeons, neurologists, and general practitioners were involved in patients' initial assessment. Three patients underwent primary amputation due to irreversible ALI, while nine underwent revascularization and one conservative treatment. Thirty-day limb salvage rate was 9/14 and thirty-day mortality was observed in one patient. Secondary interventions were needed in 65% of these cases. Patients with a delayed ALI diagnosis, when compared to those with a timely diagnosis, presented a significantly lower limb salvage rate (65% vs. 89%, p-value = 0.02) and a significantly higher rate of reinterventions (65% vs. 18%, p-value < 0.001).

Conclusions: Many patients with ALI are primarily referred to non-vascular specialties. Misdiagnosed and mistreated ALI negatively affects outcomes.

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非血管专家对急性肢体缺血的误诊会导致延迟的表现，并对患者的预后产生负面影响。

背景/目的：急性肢体缺血（ALI）是一种血管急症，伴有肢体丧失甚至死亡的重大风险。利用外科手术和/或血管内技术快速恢复动脉灌注对肢体抢救至关重要。不可否认，准确、及时的诊断是改善患者预后的第一步。典型的临床表现并不总是存在，各种症状可能导致非血管专家错过诊断。方法：在这项单中心回顾性描述性研究中，我们回顾了2018年1月至2024年1月期间因ALI住院的所有患者。确定了最初被误诊，导致诊断延迟24小时，因此没有得到及时治疗的患者。此外，我们还收集了同一时期在我院治疗的及时诊断为ALI的患者。结果：280例ALI患者中，有14例最初被误诊。从最初症状到明确诊断的中位时间为38.8天（范围1.5-365天）。一些专业如骨科医生、神经科医生和全科医生参与了患者的初步评估。3例患者因不可逆的ALI而进行了原发性截肢，9例进行了血运重建术，1例进行了保守治疗。30天肢体保留率为9/14,30天死亡1例。65%的病例需要二次干预。与及时诊断的患者相比，延迟诊断的患者肢体保留率明显较低（65%对89%，p值= 0.02），再干预率明显较高（65%对18%，p值< 0.001）。结论：许多ALI患者主要转诊到非血管专科。误诊和误治ALI会对预后产生负面影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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