Alternative diagnosis for many referred for optic neuritis
Leanne Stunkel, M.D., from the Washington University School of Medicine in St. Louis, and colleagues conducted a retrospective clinic-based cross-sectional study of new patient encounters to examine the incidence of and characterize factors contributing to overdiagnosis of acute optic neuritis. Data were included for 122 patients referred for acute optic neuritis at a neuro-ophthalmology clinic. Definite diagnosis was determined by neuro-ophthalmologists; the Diagnosis Error Evaluation and Research taxonomy tool was applied to categorize diagnostic errors for patients with alternative diagnoses.
The researchers found that 40.2 percent of the patients were confirmed to have optic neuritis and 59.8 percent had an alternative diagnosis. Headache and eye pain, functional visual loss, and other optic neuropathies were the most common alternative diagnoses. Eliciting or interpreting critical elements of history was the most common diagnostic error, which occurred in 33 percent of patients with alternative diagnoses. Errors weighing or considering alternative diagnoses, errors weighing or interpreting physical examination findings, and misinterpreting diagnostic test results were also common errors (32, 21, and 15 percent, respectively).
"Understanding pitfalls leading to overdiagnosis of optic neuritis may improve clinicians' diagnostic process," the authors write.
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