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WED 094 Diagnostic error rates in diagnosing idiopathic intracranial hypertension
  1. Scotton Sangeeta1,
  2. Liczkowski Anthony1,
  3. Mollan Susan P1,2,3,
  4. Sinclair Alexandra J1,2,3,4
  1. 1University Hospitals Birmingham
  2. 2Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham
  3. 3Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham
  4. 4Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners


Objective To quantify the rate of diagnostic error amongst patients with IIH. Additionally to identify factors contributing to diagnostic error.

Methods Sequential patients referred with a diagnosis of IIH to the Birmingham tertiary neuro-ophthalmology IIH clinic were prospectively included (October 2013- February 2017) A diagnostic error taxonomy tool was applied to cases referred as ‘definite’ or ‘possible’ IIH. Discrepancy between referred and final diagnosis were recorded.

Results 212 patients were referred, (96.2% female), 138/212 (65%) with definite IIH and 74/212 (35%) with possible IIH. Of those diagnosed with definite IIH 25% were not IIH and out of those diagnosed with possible IIH 57% were not IIH. Reasons for diagnostic error included incorrectly identifying papilloedema where in fact pseudopapilloedema existed and diagnosing IIH following an isolated lumbar puncture (LP) pressure >25 cmCSF (but in the absence of other diagnostic criteria for IIH). Misdiagnosis lead to 43% receiving unnecessary acetazolamide (or other diuretics) and 14% having multiple LPs.

Conclusions We noted a high diagnostic error rate amongst IIH patients referred to a tertiary centre for ongoing management. Where there is doubt about the presence of true papilloedema early specialist review may reduce unnecessary treatment and LP’s.

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