389例脑性瘫痪的误诊、漏诊及过度诊断原因分析

目的分析临床中对脑性瘫痪(脑瘫)的误诊、漏诊及过度诊断情况。方法对1999年7月～2010年3月住院或门诊患儿中首诊时与脑瘫的误诊、漏诊及过度诊断有关的389例患儿进行回顾性分析。结果389例患儿中，156例脑瘫患儿漏诊或误诊为营养性疾病，118例其他疾病患儿误诊为脑瘫，115例正常儿过度诊断为脑瘫；错误诊断情况与其年龄有相关性：年龄越小，越容易出现诊断错误，其中1岁以内婴儿错误诊断293例(75.3%)；2004年9月之前漏诊或误诊为其他疾病者较多，为102例(65.4%)，2004年9月之后以过度诊断较多，为87例(75.7%)，其他疾病误诊为脑瘫在2004年以后有所减少，从55.9%降至44.1%。结论提高对脑瘫的认识，正确掌握脑瘫的诊断标准非常重要。既要做到对脑瘫的早期诊断、早期治疗，以达到最佳的康复疗效，又要防止误诊及过度诊断，以致延误病情或浪费医疗资源、增加患儿家庭经济负担及心理负担。

Misdiagnosis, Missed Diagnosis and Excesseive Diagnosis Related to Cerebral Palsy: 389 Case Report

ObjectiveTo explore the state of misdiagnosis, missed diagnosis and excesseive diagnosis related to cerebral palsy(CP).Methods389 cases were retrospectively analyzed who were misdiagnosed, missed or escessively diagnosed related to CP as the first diagnosis in the inpatient and outpatient department from July 1999 to March 2010.ResultsAmong 389 cases, 156 cases were missed or misdiagnosed as nutritional disease, and 118 cases of other diseases were misdiagnosed as CP, while 115 cases who were normal children was excessively diagnosed as CP. The false diagnosis had relativity with children's age: doctors are more prone to make misdiagonsis when the children's age are smaller, while 293 cases were misdiagnosed before 12 months old (75.3%); 102 cases (65.4%) were misdiagnosed or missed as other diseases before September, 2004, while 87 cases (75.7%) were excessively diagnosed as CP after September, 2004. Frequency of misdiagnosis as CP reduced from 2004, and the proportion dropped from 55.9% to 44.1%.ConclusionIt is very important to master the diagnostic standard of CP. Both sides of the question are important, one side is to make early diagnosis and early treatment in order to achieve the best effect of rehabilitation, and the other side is to prevent misdiagnosis and excessive diagnosis which woud delay illness, or waste medical resources, increase the financial and psychological burden.