Stunkel L, et al. - This research entailed the exploration of the incidence of and characterization of the factors contributing to overdiagnosis of acute optic neuritis. Approximately 60% (95% CI, 50.6-68.6) of patients referred for optic neuritis presented with an alternative diagnosis. The most common errors were discovered to be an overreliance on a single item of history and failure to consider alternative diagnoses. The comprehension of the pitfalls leading to overdiagnosis of optic neuritis could result in an improvement in the clinicians’ diagnostic process.

Methods

• The plot of this research was a retrospective clinic-based cross-sectional study of new patient encounters.
• Researchers enrolled 122 patients referred for acute optic neuritis at a university-based Midwestern neuro-ophthalmology clinic between January 2014 and October 2016.
• Data analyses were carried out from September 2016 to July 2017.
• As a part of the interventions, definite diagnosis was determined by neuro-ophthalmologists.
• In order to categorize the type of diagnostic error, the Diagnosis Error Evaluation and Research taxonomy tool was applied for patients with alterative diagnoses.
• The main outcome included the primary type of diagnostic error in patients erroneously diagnosed as having optic neuritis.
• Final diagnosis and interventions undergone prior to referral were included as the secondary outcomes.

Results

• During the study period, 122 patients were referred with acute optic neuritis; wherein 88 (72.1%) were female, and the mean (SD) age was 42.6 (14.0) years.
• Confirmed optic neuritis was noted in 49 patients (40.2%; 95% CI, 31.4-49.4) and 73 (59.8%; 95% CI, 50.6-68.6) had an alternative diagnosis.
• Headache and eye pain, functional visual loss, and other optic neuropathies, particularly nonarteritic anterior ischemic optic neuropathy served as the most common alternative diagnoses.
• The most common diagnostic error was discovered to be the elicitation or interpretation of critical elements of history, in 24 of 73 patients (33%) with alternative diagnoses.
• Errors weighing or considering alternative diagnoses (23 patients [32%]), errors weighing or interpreting physical examination findings (15 patients [21%]), and misinterpreting diagnostic test results (11 patients [15%]) were determined to be the most common alternative diagnoses.
• Herein, 12 (16%) displayed normal magnetic resonance imaging findings preceding the referral, 12 (16%) had received a lumbar puncture, and 8 (11%) had received unnecessary treatment with intravenous steroids, among patients with alterative diagnoses.