Analysis of misdiagnosis status and influencing factors of exertional heat stroke / 解放军医学杂志

ABSTRACT

Objective To analyze the status of misdiagnosis of exertional heat stroke (EHS), its causes and influence on prognosis. Methods The clinical data of patients with EHS in 9 military hospitals from January 2012 to December 2018 were analyzed retrospectively. According to the time of diagnosis (from onset to the establishment of preliminary or suspected diagnosis), the patients were divided into ≤0.5 h, 0.5-1 h, 1-3 h, 3-6 h and >6 h groups. The number of organs involved and the clinical outcome (death or survival) of patients in each group were recorded, and the relationship between delayed diagnosis and prognostic indexes was analyzed. Through the analysis of misdiagnosis-related medical records, the distribution characteristics and possible causes of misdiagnosis were found. Results Among 122 EHS patients, 23 died, with a total fatality of 18.9%. The diagnosis time showed a skewed distribution, and the median (quartile interval) was 1.5(2.63) h. The correlation analysis between the time of diagnosis and the time of initiation of cooling showed a positive correlation (r=0.871, P<0.05). The number of involved organs increased with the delay of diagnosis, and it was significantly higher in patients diagnosed more than 6 h than that in patients diagnosed in the early stage (within 0.5 h, P<0.05). The risk of death also increased significantly with the delay of diagnosis, and the fatality rate of patients diagnosed more than 6 h was significantly higher than that of patients diagnosed in the early stage (within 0.5 h, P<0.05). The composition ratio of misdiagnosis varied with time. The misdiagnosis rate within 0.5 hours of onset was 87.7%. The diagnosis was mainly based on symptomatic description (64.5%), followed by misdiagnosis as nervous system disease (24.3%). The main causes for the delay in diagnosis were the lack of typical clinical manifestations in the early stage of the disease and the lack of understanding of the disease in the on-site emergency medical personnel. Conclusions The misdiagnosis rate would be high in the early stage of EHS, and it may be significantly related to organ injury and prognosis. The main cause of misdiagnosis in the early stage of EHS might be the lack of understanding of the disease in the on-site emergency medical personnel, which suggests an urgent need to improve the EHS recognition by on-site emergency medical personnel.