Misdiagnosis of thrombotic microangiopathy in the emergency department: a multicenter retrospective study.
Emergency department
Hemolytic-uremic syndrome
Thrombotic microangiopathy
Thrombotic thrombocytopenic purpura
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
01 Nov 2023
01 Nov 2023
Historique:
received:
28
07
2023
accepted:
08
10
2023
medline:
2
11
2023
pubmed:
2
11
2023
entrez:
2
11
2023
Statut:
aheadofprint
Résumé
To estimate the rate of inappropriate diagnosis in patients who visited the ED with thrombotic microangiopathy (TMA) and to assess the factors and outcomes associated with emergency department (ED) misdiagnosis. Retrospective multicenter study of adult patients admitted to the intensive care unit (ICU) for TMA from 2012 to 2021 who had previously attended the ED for a reason related to TMA. Patient characteristics and outcomes were compared in a univariate analysis based on whether a TMA diagnosis was mentioned in the ED or not. Forty patients were included. The diagnosis of TMA was not mentioned in the ED in 16 patients (40%). Patients for whom the diagnosis was mentioned in the ED had more frequently a request for schistocytes research, and therefore had more often objectified schistocytes. They also had more frequently a troponin dosage in the ED (even if the difference was not significant), an ECG performed or interpreted, and were admitted more quickly in the ICU (0 [0-0] vs 2 [0-2] days; P = 0.002). Hemoglobin levels decreased significantly in both groups, and creatinine levels increased significantly in the misdiagnosis group between ED arrival and ICU admission. In patients with a final diagnosis of TTP, the time to platelets durable recovery was shorter for those in whom the diagnosis was mentioned in the ED without reaching statistical significance (7 [5-11] vs 14 [5-21] days; P = 0.3).
Identifiants
pubmed: 37914919
doi: 10.1007/s11739-023-03457-8
pii: 10.1007/s11739-023-03457-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).
Références
Moake JL (2002) Thrombotic microangiopathies. N Engl J Med 347:589–600
doi: 10.1056/NEJMra020528
pubmed: 12192020
Mariotte E, Azoulay E, Galicier L, Rondeau E, Zouiti F, Boisseau P et al French Reference Center for Thrombotic Microangiopathies (2016) Epidemiology and pathophysiology of adulthood-onset thrombotic microangiopathy with severe ADAMTS13 deficiency (thrombotic thrombocytopenic purpura): a cross-sectional analysis of the French national registry for thrombotic microangiopathy. Lancet Haematol 3:e237–e245
Fodil S, Zafrani L (2022) Severe thrombotic thrombocytopenic purpura (TTP) with organ failure in critically ill patients. J Clin Med 11:1103
doi: 10.3390/jcm11041103
pubmed: 35207375
pmcid: 8874413
Coppo P, Veyradier A (2009) Thrombotic microangiopathies: towards a pathophysiology-based classification. Cardiovasc Hematol Disord Drug Targets 9:36–50
doi: 10.2174/187152909787581318
pubmed: 19275576
Grall M, Azoulay E, Galicier L, Provôt F, Wynckel A, Poullin P et al (2017) Thrombotic thrombocytopenic purpura misdiagnosed as autoimmune cytopenia: causes of diagnostic errors and consequence on outcome. Experience of the French thrombotic microangiopathies reference centre. Am J Hematol 92:381–387
doi: 10.1002/ajh.24665
pubmed: 28133771
Renaud A, Caristan A, Seguin A, Agard C, Blonz G, Canet E et al (2021) Deleterious neurological impact of diagnostic delay in immune-mediated thrombotic thrombocytopenic purpura. PLoS ONE 16:e0260196
doi: 10.1371/journal.pone.0260196
pubmed: 34797873
pmcid: 8604371
Coppo P, Schwarzinger M, Buffet M, Wynckel A, Clabault K, Presne C et al (2010) Predictive features of severe acquired ADAMTS13 deficiency in idiopathic thrombotic microangiopathies: the French TMA reference center experience. PLoS ONE 5:e10208
doi: 10.1371/journal.pone.0010208
pubmed: 20436664
pmcid: 2859048
Schmidt J, Zafrani L, Lemiale V, Stepanian A, Joly B, Azoulay E et al (2021) The clinical picture of thrombotic microangiopathy in patients older than 60 years of age. Br J Haematol 192:e25–e28
doi: 10.1111/bjh.17176
pubmed: 33216950
Long B, Bridwell RE, Manchanda S, Gottlieb M (2021) Evaluation and management of thrombotic thrombocytopenic purpura in the emergency department. J Emerg Med 61:674–682
doi: 10.1016/j.jemermed.2021.07.045
pubmed: 34518045
Kessler CS, Khan BA, Lai-Miller K (2012) Thrombotic thrombocytopenic purpura: a hematological emergency. J Emerg Med 43:538–544
doi: 10.1016/j.jemermed.2012.01.027
pubmed: 22445678
Page EE, Kremer Hovinga JA, Terrell DR, Vesely SK, George JN (2017) Thrombotic thrombocytopenic purpura: diagnostic criteria, clinical features, and long-term outcomes from 1995 through 2015. Blood Adv 1:590–600
doi: 10.1182/bloodadvances.2017005124
pubmed: 29296701
pmcid: 5728353
Scully M, Yarranton H, Liesner R, Cavenagh J, Hunt B, Benjamin S et al (2008) Regional UK TTP registry: correlation with laboratory ADAMTS 13 analysis and clinical features. Br J Haematol 142:819–826
doi: 10.1111/j.1365-2141.2008.07276.x
pubmed: 18637802
Peyrony O, Gamelon D, Brune R, Chauvin A, Ghazali DA, Yordanov Y et al (2021) Red blood cell transfusion in the emergency department: an observational cross-sectional multicenter study. J Clin Med 10:2475
doi: 10.3390/jcm10112475
pubmed: 34199655
pmcid: 8199757
Demagny J, Roussel C, Le Guyader M, Guiheneuf E, Harrivel V, Boyer T et al (2022) Combining imaging flow cytometry and machine learning for high-throughput schistocyte quantification: a SVM classifier development and external validation cohort. EBioMedicine 83:104209
doi: 10.1016/j.ebiom.2022.104209
pubmed: 35986949
pmcid: 9404284
Deford CC, Reese JA, Schwartz LH, Perdue JJ, Kremer Hovinga JA, Lämmle B et al (2013) Multiple major morbidities and increased mortality during long-term follow-up after recovery from thrombotic thrombocytopenic purpura. Blood 122:2023–2029
doi: 10.1182/blood-2013-04-496752
pubmed: 23838348
pmcid: 3778546
Scully M, Rayment R, Clark A, Westwood JP, Cranfield T, Gooding R et al BSH Committee (2023) A British society for haematology guideline: diagnosis and management of thrombotic thrombocytopenic purpura and thrombotic microangiopathies. Br J Haematol https://doi.org/10.1111/bjh.19026
HaemSTAR Collaborators (2022) Diagnostic uncertainty presented barriers to the timely management of acute thrombotic thrombocytopenic purpura in the United Kingdom between 2014 and 2019. J Thromb Haemost 20:1428–1436
Benhamou Y, Boelle PY, Baudin B, Ederhy S, Gras J, Galicier L et al Reference Center for Thrombotic Microangiopathies (2015) Cardiac troponin-I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center. J Thromb Haemost 13:293–302
Van de Louw A, Mariotte E, Darmon M, Cohrs A, Leslie D, Azoulay E (2021) Outcomes in 1096 patients with severe thrombotic thrombocytopenic purpura before the Caplacizumab era. PLoS ONE 16:e0256024
doi: 10.1371/journal.pone.0256024
pubmed: 34383822
pmcid: 8360509
Sawler D, Parker A, Britto J, Goodyear MD, Sun HL (2020) Time from suspected thrombotic thrombocytopenic purpura to initiation of plasma exchange and impact on survival: a 10-year provincial retrospective cohort study. Thromb Res 193:53–59
doi: 10.1016/j.thromres.2020.05.045
pubmed: 32521335
Benhamou Y, Baudel JL, Wynckel A, Galicier L, Azoulay E, Provôt F et al (2015) Are platelet transfusions harmful in acquired thrombotic thrombocytopenic purpura at the acute phase? Experience of the French thrombotic microangiopathies reference center. Am J Hematol 90:E127–E129
doi: 10.1002/ajh.23997
pubmed: 25740210
Mariotte E, Blet A, Galicier L, Darmon M, Parquet N, Lengline E et al (2013) Unresponsive thrombotic thrombocytopenic purpura in critically ill adults. Intensive Care Med 39:1272–1281
doi: 10.1007/s00134-013-2873-4
pubmed: 23549631
Zheng XL, Vesely SK, Cataland SR, Coppo P, Geldziler B, Iorio A et al (2020) ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura. J Thromb Haemost 18:2486–2495
doi: 10.1111/jth.15006
pubmed: 32914582
pmcid: 8146131
Bendapudi PK, Hurwitz S, Fry A, Marques MB, Waldo SW, Li A et al (2017) Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. Lancet Haematol 4:e157–e164
doi: 10.1016/S2352-3026(17)30026-1
pubmed: 28259520