Multiple Health Care Encounters Prior to Diagnosis of Cerebral Venous Thrombosis

Study objective Cerebral venous thrombosis symptom onset can be insidious and without focal deficits. We performed a planned analysis of care-seeking patterns prior to diagnosis in a Canadian randomized trial examining treatment and prognosis of cerebral venous thrombosis and its companion prospective observational registry to examine whether time to diagnosis or multiple health care encounters prior to diagnosis were associated with 180-day outcomes. Methods Adults within 14 days of diagnosis of a new symptomatic cerebral venous thrombosis were included. We examined timing from symptom onset to diagnosis and the number of health care encounters for cerebral venous thrombosis symptoms prior to diagnosis. We explored associations between multiple care encounters prior to diagnosis with patient demographics, baseline clinical and radiologic features, and 180-day outcomes. Results Of 102 patients (median age 45 [interquartile range {IQR} 31.0 to 61.0] years, 68.6% women), 40 (39%) had multiple health care encounters for their cerebral venous thrombosis symptoms prior to diagnosis. The median time from symptom onset to diagnosis was 4 (IQR 1 to 8) days. Women had a longer time from symptom onset to diagnosis compared with men (median 5 days [IQR 2 to 8 days] versus 2 days [IQR 1 to 4.5 days]), difference 3 days, 95% confidence interval [CI] 1 to 5 days) and were almost twice as likely as men to have had multiple health care encounters prior to diagnosis (46% versus 25%, difference 21%, 95% CI, 2 to 40). Time from symptom onset to diagnosis and number of health care encounters prior to diagnosis were not associated with adverse 180-day outcomes. Conclusion Women were more likely to have multiple health care encounters prior to cerebral venous thrombosis diagnosis. However, this was not associated with worse outcomes.