TITLE:
Room for improvement: Patterns of referral misdiagnosis to a vascular anomalies center
AUTHORS:
Daniel E. Levin, Allison L. Speer, James R. Pierce, Donna Nowicki, Alex Arkader, Philip Stanley, Andre Panossian, Dean M. Anselmo
KEYWORDS:
Vascular Anomaly; Misdiagnosis; Venous Malformation; Infantile Hemangioma; Arteriovenous Malformation; Vascular Anomalies Center
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.3 No.4,
November
28,
2013
ABSTRACT:
Objective: Vascular anomalies are a diagnostic and
therapeutic challenge. Errors in diagnosis lead to treatment delay,
inappropriate interventions and prolonged suffering. The aim of this study was
to analyze patterns of misdiagnosis among patients referred to a vascular
anomalies center (VAC). This will better define the problem and may be used to
refine and improve referral guidelines for patients with vascular anomalies. Patients
and Methods: After IRB approval, we performed a single-center retrospective
review of all patients referred to a vascular anomaly between January 1, 2008
and December 15, 2011. Evaluation of both referral and final diagnosis was
made. Data regarding accuracy of diagnosis were determined and compared for
both vascular tumors and malformations. Results: Mean age was 7.9 ± 7.7 (13 days - 66 years). 42% had a correct diagnosis at the time of referral. Vascular
tumors were correctly diagnosed more often than vascular malformations (58% vs
38%). The most common misdiagnosis for infantile hemangioma (IH) was venous
malformation (VM). The most common misdiagnosis for VM was IH. Nonspecific and
historical terms such as “mass”, “lymphangioma”, and “cavernous hemangioma”
frequently appear as the referral diagnosis. Conclusion: Referral misdiagnosis
is common. IH and VM are frequently confused and if there is any uncertainty in
the diagnosis, these patients should also be referred to a VAC, in addition to
the more complicated anomalies. Outdated nomenclature remains prevalent and
continued efforts should be made to adhere to International Society for the
Study of Vascular Anomalies (ISSVA)
classification. Improvements in diagnostic accuracy are likely to
greatly improve patients’ care.