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Misdiagnosis of thrombotic microangiopathy in the emergency department: a multicenter retrospective study

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Abstract

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).

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Acknowledgements

Authors would like to thank OP’s post-doctoral fellow financial support: la Ligue Nationale contre le Cancer (convention number: AAPMRC 2022/OP) and la Direction de l'Assistance Publique—Hôpitaux de Paris (APHP).

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Author information

Authors and Affiliations

  1. Nantes University, Nantes, France

    Isaure de Boisriou

  2. Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France

    Sami Ellouze & Olivier Peyrony

  3. Emergency Department, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France

    Christian Kassasseya & Mehdi Khellaf

  4. Emergency Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Paris, France

    Anne-Laure Feral-Pierssens

  5. Emergency Department, Groupe Hospitalier Paris-Saint-Joseph, Paris, France

    Camille Gerlier

  6. Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France

    Anthony Chauvin

  7. Emergency Department, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Paris, France

    Sebastien Beaune

  8. Université Versailles St Quentin- UFR Simone Veil santé, Montigny-le-Bretonneux, France

    Sebastien Beaune

  9. Emergency Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France

    Evelyne Dubreucq

  10. Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France

    Laurent Pereira

  11. Emergency Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France

    Richard Chocron

  12. INSERM, UMR-S970, Paris Cardiovascular Research Center, Team “Integrative Epidemiology of Cardiovascular Diseases”, Université Paris Cité, Paris, France

    Richard Chocron

  13. Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France

    Éric Mariotte & Lara Zafrani

Authors
  1. Isaure de Boisriou
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  2. Sami Ellouze
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  3. Christian Kassasseya
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  4. Anne-Laure Feral-Pierssens
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  5. Camille Gerlier
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  6. Anthony Chauvin
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  7. Sebastien Beaune
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  8. Evelyne Dubreucq
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  9. Laurent Pereira
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  10. Richard Chocron
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  11. Mehdi Khellaf
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  12. Éric Mariotte
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  13. Lara Zafrani
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  14. Olivier Peyrony
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Contributions

Conception and design: IdB, LZ, OP. Provision of study materials of patients: SE, CK, ALFP, CG, AC, SB, ED, LP, RC, MK, EM, LZ. Collection and assembly of data: IdB, SE, LZ, OP. Data analysis and interpretation: IdB, OP. Manuscript writing: IdB, OP. Final approval of manuscript: IdB, SE, CK, ALFP, CG, AC, SB, ED, LP, RC, MK, EM, LZ, OP.

Corresponding author

Correspondence to Olivier Peyrony.

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Conflict of interest

OP has received honoraria for talks on behalf of BMS and Qiagen, and expertise for Sanofi. EM has received lecture fees from Sanofi and Takeda. LZ reports receiving fees for lectures for MSD and Sanofi and her institution received a research grant from Jazz Pharmaceuticals.

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Not applicable.

Ethical approval

The collection and use of data was approved by the institutional review board (CIC Clermont-Ferrand — IRB no. 5891; Ref: 2007–16).

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de Boisriou, I., Ellouze, S., Kassasseya, C. et al. Misdiagnosis of thrombotic microangiopathy in the emergency department: a multicenter retrospective study. Intern Emerg Med 19, 115–124 (2024). https://doi.org/10.1007/s11739-023-03457-8

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  • DOI: https://doi.org/10.1007/s11739-023-03457-8

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