The Impact of Misdiagnosis of Acute Limb Ischemia by Non-Vascular Specialists on Patient Outcomes: A Delayed Presentation Perspective

Аннотация

Acute limb ischemia (ALI) is a life-threatening condition that requires immediate intervention to prevent severe complications, including limb loss and death. This study investigates the impact of misdiagnosis of ALI by non-vascular specialists and how delayed recognition and treatment negatively affect patient outcomes. A retrospective analysis of medical records was performed on patients diagnosed with ALI who initially presented to non-vascular specialists. The results demonstrate that misdiagnosis or delayed diagnosis led to significant delays in treatment, increasing the risk of long-term disability, amputation, and mortality. The study underscores the importance of enhancing diagnostic skills among non-vascular healthcare providers and improving the overall recognition of ALI in emergency settings to reduce delays and improve patient prognosis. Keywords: Acute limb ischemia, misdiagnosis, non-vascular specialists, delayed presentation, patient outcomes, vascular emergencies, clinical diagnosis, limb amputation, healthcare quality, diagnostic accuracy. as general practitioners, emergency room physicians, Introduction: Acute limb ischemia (ALI) is a severe and or internists—rather than vascular experts. This delay urgent condition characterized by a sudden reduction in referring patients to vascular specialists or making a or cessation of blood flow to the limbs, often due to correct diagnosis contributes to what is known as embolism, thrombosis, or trauma. It is considered a misdiagnosis and delayed diagnosis, both of which can vascular emergency that demands immediate diagnosis exacerbate the condition and worsen clinical and intervention to prevent irreversible tissue damage, outcomes. Non-vascular specialists, due to their gangrene, limb loss, or even death. The early generalist training, may overlook or misinterpret the identification and prompt treatment of ALI are early symptoms of ALI. Common misdiagnoses include paramount in improving patient outcomes, yet the musculoskeletal injuries, peripheral neuropathy, timely diagnosis of this condition remains a challenge infection, or trauma. These conditions share in clinical practice. overlapping symptoms with ALI, such as pain, swelling, The pathophysiology of ALI involves the occlusion of or pallor, which can delay the correct diagnosis of the major blood vessels supplying the limb, leading to ischemia. inadequate perfusion of tissues. This condition can For instance, musculoskeletal injuries such as sprains or rapidly progress to more severe outcomes if left strains often present with pain and swelling in the limb, untreated, such as tissue necrosis, infection, or multi- symptoms that can superficially resemble ALI. Similarly, organ failure. According to studies, if left untreated for infection and inflammatory conditions can cause a period longer than 6 hours, the chances of saving the swelling, redness, and pain, which may obscure the affected limb dramatically decrease, with the risk of presence of vascular compromise. In such cases, the irreversible damage increasing substantially. failure to immediately recognize ALI and perform Despite the severity and urgency of ALI, many patients further diagnostic evaluations, such as duplex initially seek care from non-vascular specialists—such ultrasonography or CT angiography, can lead to a International Journal of Medical Sciences And Clinical Research 91 https://theusajournals.com/index.php/ijmscr International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265) critical delay in treatment. to the affected limb. The consequences of delayed treatment in ALI are This article aims to explore how misdiagnosis by non- severe. If patients do not receive early vascular specialists leads to delayed presentation and revascularization—a procedure that restores blood worsens patient outcomes. By reviewing patient flow to the ischemic limb—tissue death and gangrene records and analyzing the consequences of diagnostic can set in quickly. This necessitates amputation of the delays, we assess the role of non-vascular specialists in limb to prevent the spread of infection and systemic the recognition of ALI and propose strategies to failure. Furthermore, delayed treatment is associated improve diagnostic accuracy. with an increased risk of death, especially in patients METHODS who experience systemic complications due to Study Design prolonged ischemia. In some studies, the delay in treatment by more than 12 hours has been linked to a This study is a retrospective cohort analysis of patients significantly higher mortality rate, highlighting the diagnosed with acute limb ischemia who initially critical nature of early diagnosis and intervention. presented to non-vascular specialists before being referred to a vascular surgeon or specialist. Data were Given the significant impact of diagnostic delay on obtained from electronic medical records (EMRs) of patient outcomes, it is essential to investigate ho