Misdiagnosis Of Infective Endocarditis

Objective:To summarize the clinical data and treatments process of infective endocarditis,analyze the causes of misdiagnosis,deepen clinicians' understanding of the disease,and reduce misdiagnosis.Methods:A total of 84 patients(age from 11 to 77 years,median age 39.5 years)with infective endocarditis(IE)diagnosed in our department from January 2008 to January 2018 were retrospectively analyzed.There were 62 males(73.8%)and 22 females(26.2%),with a male/female ratio of 2.8:1.The clinical data of patients were summarized.When patients met the suspected diagnosis conditions of IE,they would be divided into diagnosed group and misdiagnosed group according to physicians' awareness of the possibility of IE.The differences between the two groups were analyzed in order to find out valuable clues of early diagnosis,which were ignored by physicians.Results:Patients with body temperature above 38? accounted for 97.6%(82/84),with heart murmur took up 82.1%(69/84),with splenomegaly occupied 27.4%(23/84),with heart failure were 27.4%(23/84),and with embolism were 46.4%(39/84).In this group,the misdiagnosis rate of the first diagnosis was 73.8%,and upper respiratory tract infection,uncertain infection cause to be investigated and lower respiratory tract infection were the common misdiagnosis diseases.In the process of treatments,doctors' overlook of IE predisposition factors(P=0.001),vascular signs(P=0.001),heart murmur(P=0.034),embolism(P=0.004)and other clinical manifestations led to misdiagnosis.With the increase of ignored minor criteria(P=0.005),misdiagnosis was more likely to occur.Therefore,the difference between the two groups were statistically significant.Conclusion:IE is a disease with a high misdiagnosis rate.For patients with recurrent fever of unknown origin,heart murmur,vascular signs such as complicated embolism and various factors prone to IE,doctors should be alert to the possibility of IE and use the diagnostic cornerstone of IE timely.For the purpose of reducing misdiagnosis,we should improve the cognition of IE and strengthen multi-professional cooperation.