RT Journal Article
SR Electronic
T1 WED 094 Diagnostic error rates in diagnosing idiopathic intracranial hypertension
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP A10
OP A10
DO 10.1136/jnnp-2018-ABN.36
VO 89
IS 10
A1 Scotton Sangeeta
A1 Liczkowski Anthony
A1 Mollan Susan P
A1 Sinclair Alexandra J
YR 2018
UL http://jnnp.bmj.com/content/89/10/A10.1.abstract
AB 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.