成人破伤风首诊误诊和漏诊分析  

Mis-and missed-diagnosis of adult tetanus cases at the first visit

作　　者：冯珂[1] 勾燚 毛楚恒 李生明 吕博辉 张俊飞 陈中伟[1] Feng Ke;Gou Yi;Mao Chuheng;Li Shengming;Lyu Bohui;Zhang Junfei;Chen Zhongwei(Department of Emergency,the General Hospital of Ningxia Medical University,Yinchuan 750000,China;Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院急诊科,银川750000 [2]宁夏医科大学,银川750004

出　　处：《创伤外科杂志》2023年第7期528-532,共5页Journal of Traumatic Surgery

基　　金：2022年宁夏回族自治区重点研发计划项目(2022BEG02049);2023年自治区自然科学基金重点项目(2023AAC02068)。

摘　　要：目的分析成人破伤风首诊误诊和漏诊原因,以降低其首诊误诊和漏诊率。方法回顾性收集2010年1月—2022年12月宁夏医科大学总医院急诊科收治的破伤风患者临床资料和首诊诊断情况,根据首诊诊断情况分为正确诊断组(24例)、误诊组(13例)和漏诊组(12例),比较三组之间性别、年龄、潜伏期、职业和症状等的差异。结果研究共纳入49例病例,年龄21~78岁,平均52.7岁,中位潜伏期为10(5,15)d。成人破伤风首诊误诊和漏诊率分别为26.5%(13/49)和24.5%(12/49),主要被误诊为脑梗死和颞下颌关节病变,占比分别为53.8%(7/13)、23.1%(3/13)。单因素分析显示,性别、致伤机制、颅脑MRI/CT结果和肢体强直在成人破伤风首诊诊断情况中差异有统计学意义(P<0.05)。职业、受伤部位、Ablett分级、首诊医院级别等在成人破伤风首诊诊断情况之间差异无统计学意义(P>0.05)。结论成人破伤风首诊容易被误诊和漏诊,女性、非典型创伤、颅脑MRI/CT阳性、肢体强直患者首诊正确诊断率更低,更容易被误诊和漏诊。Objective To analyze the causes of mis-and missed-diagnosis of tetanus at the first visit and to reduce the incidence.Methods Clinical data of adult patients with tetanus treated at the General Hospital of Ningxia Medical University from Jan.2010 to Dec.2022 and theiRdiagnosis at first visit were retrospectively collected.Based on the initial diagnosis,patients were divided into correct diagnosis group(n=24),misdiagnosis group(n=13)and missed diagnosis group(n=12).Parameters of gender,age,incubation period,occupation,symptoms,etc.were compared among the three groups.Results During the study period,49 cases were included,with the age range 21-78 years,mean 52.7 years.The median incubation period was 10(5,15)days.At the first visit,theiRrate of missed diagnosis was 24.5%(12/49)while misdiagnosis was 26.5%(13/49),mainly misdiagnosed as cerebral infarction(53.8%,7/13)and temporomandibulaRjoint disorders(23.1%,3/13).Univariate analysis showed statistical significance in gender,injury mechanism,brain MRI/CT results and limb rigidity at the first visit of adult tetanus(P<0.05),but occupation,injury site,Ablett classification and level of the first visit hospital revealed no significant difference(all P>0.05).Conclusion Adult tetanus is easily misdiagnosed and missed at the first diagnosis.Female,atypical trauma,positive results of brain MRI/CT and limb rigidity patients have loweRincidence of correct diagnosis,who are more likely to be mis-oRmissed-diagnosed.

关 键 词：破伤风 误诊 漏诊 

分 类 号：R517.3[医药卫生—内科学]