title: Education of referring doctors about sudden onset headache in subarachnoid hemorrhage. A prospective study.
abstract: OBJECTIVE
  Forty percent of patients with aneurysmal subarachnoid hemorrhage have prodromal warning episodes and difficulties in identifying these events are repeatedly documented. Modifications of diagnostic and referral patterns through educational programs of local doctors may help to identify such patients before a major devastating rupture occurs.
  
  
  METHODS
  A teaching program about sudden onset headache, targeting referring doctors, was systematically applied and its impact on early misdiagnosis of ruptured aneurysms was prospectively studied.
  
  
  RESULTS
  Forty percent of all studied patients experienced a warning episode, manifested as apoplectic headache, prior to hospitalization. An initial diagnostic error was evident in 12% of the patients. Diagnostic errors were reduced by 77% as a result of continuous interaction between neurosurgeons and local physicians.
  
  
  CONCLUSIONS
  Misdiagnosed warning episodes cause greater loss of lives and higher morbidity on a population basis than does delayed ischemic complications from vasospasm in aneurysmal SAH. Teaching programs focused on local physicians have a profound impact on outcome at low cost.
authors.affiliation: Departments of Neurosurgery and Neurology, University Hospital, Linköping, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Fridriksson
authors.forename: J
authors.initials: J
authors.lastname: Hillman
authors.forename: A M
authors.initials: AM
authors.lastname: Landtblom
authors.forename: J
authors.initials: J
authors.lastname: Boive
mesh_terms: D003951:Diagnostic Errors / Q000517:prevention & control*; D004496:Education, Continuing; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D011446:Prospective Studies; D012017:Referral and Consultation; D013129:Spinal Puncture; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed