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PubMed2003

Features involved in the diagnostic delay of cluster headache.

BACKGROUND: Cluster headache (CH) is a comparatively rare, very severe primary headache. Although circumscript and recognisable criteria are available, the diagnosis is often missed or delayed. Besides, while adequate and evidence based treatment is available in diagnosed cases, CH seems to be poorly managed. The authors performed a nationwide survey among CH patients, and looked for factors involved in the diagnostic delay. METHODS: The authors performed a nationwide mailing to all Dutch general practitioners (about 5800), and neurologists (about 560) and invited them to refer patients in whom the diagnosis CH was made or considered. Patients could also apply via the Dutch Headache Patients Society. A variety of clinical characteristics were assessed by means of questionnaires. Specifically, patients were asked about the time between their first episode and the diagnosis. RESULTS: The IHS criteria for CH were met by 1429 of 2001 responders, and 1163 of these filled in an extended questionnaire. The male to female ratio was 3.7:1. Mean age at onset was 32 (SD 14) years. Seventy three per cent had episodic CH, 21% had chronic CH, and in 6% the periodicity was undetermined. The time between the first episode and the diagnosis ranged from 1 week to 48 years (median 3 years): 34% had consulted a dentist and 33% an ENT specialist before the diagnosis was established. Among factors that increased the diagnostic delay were the presence of photophobia or phonophobia, nausea, an episodic attack pattern and a low age at onset (p<0.01). Sex or presence of restlessness during episodes did not influence the diagnostic delay. CONCLUSION: CH remains unrecognised or misdiagnosed in many cases for many years. Photophobia or phonophobia and nausea were in part responsible for this delay, and should be recognised as part of the clinical spectrum of CH. Many patients were first seen by a dentist or ENT specialist for their CH episodes, so more attention should be paid to educate first line physicians to recognise CH, to improve the diagnostic process and so to expose patients to earlier and better treatment of CH.

Adult↗
PubMed2005

Impact of patient and professional diagnostic delays on the risk of recurrence in laryngeal carcinoma.

OBJECTIVES: To evaluate the impact of patient and professional diagnostic delays on the risk of recurrence in laryngeal squamocellular carcinoma (LSCC). DESIGN: Retrospective study using primary health care records completed before the diagnosis of malignancy. SETTING: One primary health care district (onset of symptoms), one tertiary centre (final diagnosis). PARTICIPANTS: A population-based sample of 99 patients, of which 66 fulfilled the entry criteria, with LSCC diagnosed in northern Finland in 1990-1995. MAIN OUTCOME MEASURES: Impact of patient delay (interval between the onset of symptoms and the first visit to a physician) and professional delay (interval between the first medical visit and histologically verified diagnosis) on the risk of local, neck and distant recurrence in LSCC. RESULTS: Professional delay of 1 year or longer was an independent predictor of both local [adjusted relative hazard (HR) 4.62, P = 0.02] and neck (HR 9.5, P = 0.015) recurrence. Longer professional delay was associated with the risk of recurrence particularly among patients with early stage (stages I-II) disease. Professional delay was almost exclusively because of a delay in referring patients from primary care to an ENT centre. CONCLUSIONS: Lengthened professional diagnostic delay is an independent predictor of an increased risk of local and neck recurrence in early stage LSCC. These patients could benefit from more aggressive primary treatment or more meticulous follow-up.

Adult↗
PubMed2005

Role of alcohol and smoking in diagnostic delay of head and neck cancer patients.

CONCLUSIONS: This study shows that heavy drinking is a risk factor for prolonged delay in presenting with head and neck cancer and for presenting with a large tumour in the head and neck region. Excessive smoking is only a risk factor for being diagnosed with a large tumour, although there is a weak association between smoking and prolonged diagnostic delay. OBJECTIVE: It is reasonable to assume that prolonged delay in presenting with head and neck cancer is associated with an advanced stage of cancer at diagnosis. In this study we analysed the effects of drinking and smoking habits on diagnostic delay and the T stage of the tumour at diagnosis. MATERIAL AND METHODS: A total of 427 patients with newly diagnosed head and neck carcinomas were eligible for this study. Of these, 306 (72%) actually participated: 134 (77%) with an oral tumour; 117 (69%) with a larynx tumour; and 55 (65%) with a pharynx tumour. Diagnostic delay was defined as a period of >30 days between the appearance of the first tumour-related symptoms and the first visit to a physician. T3 4 tumours were defined as advanced tumours. Drinking behaviour was classified into three types: light (0 2 drinks/day); moderate (3 4 drinks/day); and heavy ( >4 drinks/day). Smoking habits were classified into 4 types: never; stopped; light (0 20 cigarettes/day); and heavy (>20 cigarettes/day). RESULTS: Logistic regression showed that there were significantly more heavy than light drinkers [p = 0.04; odds ratio (OR) 1.8; 95% CI 1.0-3.1] in the delay group than in the non-delay group. Light smokers showed a tendency towards prolonged delay (p = 0.06; OR 2.2; 95% CI 1.0-5.0). Both heavy drinking (p = 0.01; OR 2.0; 95% CI 1.2-3.6) and heavy smoking (p = 0.03; OR 3.1; 95% CI 1.1-8.4) were risk factors for a patient to be diagnosed with a large tumour.

Adult↗
PubMed2005

Primary antibody deficiency and diagnostic delay.

AIMS: To assess the occurrence of diagnostic delay in primary antibody deficiency in the period 1989-2002, since a similar study in 1989, and to assess the impact of UK national guidelines communicated in 1995. METHODS: A retrospective case note review was performed of 89 consecutive patients with antibody deficiency referred to a regional referral centre for clinical immunology in north west England and north Wales. The delay in diagnosis and the estimated resulting morbidity in terms of infections were assessed. RESULTS: Fifty six of the 89 patients experienced delay in diagnosis. The overall median delay was 2 years (mean, 4.4), resulting in substantial morbidity (equivalent to two major infections and one minor infection). This shows a moderate improvement since the previous study in 1989 and since the introduction of UK national guidelines in 1995. Respiratory infections are the most frequent presenting infections, and respiratory physicians the most common source of referral. CONCLUSIONS: There is still considerable delay in the diagnosis of primary antibody deficiency, but the data suggest an improvement in practice since the previous study in 1989 and the distribution of national guidelines in 1995.

Adolescent↗
PubMed1994

Hearing impairment in Oslo born children 1989-91. Incidence, etiology and diagnostic delay.

An investigation of incidence, etiology and diagnostic delay was performed in Oslo born children referred to the audiological department of Ullevål Hospital in the period 1989-91; hearing loss in these children required amplification and audiopedagogical training. An increase in incidence compared with 1975-84 was found. No child had a hearing loss caused by rubella. The age at time of diagnosis is increased, with a median age of 28 months. Children with moderate hearing losses are diagnosed at later ages. A considerable delay in the diagnosis of hearing-impaired children is shown.

Child, Preschool↗
PubMed1993

[Diagnostic delay and related factors in women with breast cancer].

This was a retrospective descriptive study examining responses to the discovery of breast symptoms and the determinants of delay in diagnosis of women with breast cancer. There were 71 women recruited from a medical center Out-Patient Department (OPD) and asked to complete structured questionnaires. On completion of the questionnaires face-to-face interviews were conducted in private. The validity and reliability of the instruments were measured and the correlation coefficients were found to be acceptable (0.64-0.84). Ninety-six percent of the women had self-discovered breast symptoms that included breast lumps, sensation of pain, nipple retraction and nipple secretion. Responses to the discovery were categorized as "worry or fear", "have no unusual sensation", "suspicion", "wait and see", "feel sorry" and "prayer". The time delay between discovery of breast cancer symptoms and pathological diagnosis ranged from less than one week to over six months. Stepwise multiple regressions were computed. The socioeconomic status, education, and Powerful Others Health Locus of Control (PHLC) were the most powerful predictors; together they explained 46% of the variance for diagnostic delay. Also, we found diagnostic delay was significantly correlated with the clinical stage when Sperman's correlation was tested (r = 0.73, P < 0.01). It was indicated that subjects with delayed diagnosis showed a possibility of poorer prognosis at the clinical stage. Nursing implications and strategies are discussed.

Adult↗
PubMed1999

Diagnostic delays in head and neck cancers.

Head and neck cancers are a significant and worsening health problem in the UK. In the absence of screening, minimising diagnostic delay after the onset of symptoms improves prognosis. Delay, from the patient's initial experience of symptoms to the ultimate diagnosis, consists of two elements--the delay prior to presenting to a clinician plus that due to the health professional consulted. This study aimed to establish the period of delay between recognition of the initial tumour symptoms and the formal diagnosis among a sample of patients recently diagnosed with head and neck cancer. Using a semistructured questionnaire, 133 men and 55 women were interviewed by a research nurse, and the results were related to the clinical findings. Tumour size at diagnosis was classified according to T1 (22%), T2 (29%), T3 (27%) and T4 (22%). Of the 186 patients with complete hospital records, 48 (26%) were diagnosed with cancer of the lip and oral cavity (CLOC). From the onset of symptoms to the patients' initial decision to seek professional advice, the median period was 4 weeks among those with CLOC and 3 weeks for those with other head and neck cancers (OHNC). The distribution was highly skewed with delays beyond 6 months occurring among 9% of the OHNC group, compared with 3% of CLOC. From the onset of symptoms to a consultant appointment, the median delay was 8 weeks for OHNC, but 12 weeks for CLOC, with delays beyond 6 months of 13% in each group, respectively. First symptoms included 'change in voice' (26%), 'pain' (27%), 'lump' or 'growth' (12%) as well as dysphagia, 'infection', 'sore throat', 'ulcers' or 'abscess'. No significant association was found between the nature of the first symptoms and the urgency with which patients interpreted their symptoms, nor was this related to diagnostic delay, sex, age or social class. It is concluded that there is substantial variation in time to clinical presentation, particularly for OHNC, although professional delay for the majority of these cases was minimal. For patients with CLOC there was less variation in patient delay, but clinician delay was relatively longer.

Adult↗
PubMed2005

The idiosyncratic relationship between diagnostic delay and stage of oral squamous cell carcinoma.

Approximately half of patients with oral cancer present with advanced lesions when five-year survival rates are as low as 20%, however, diagnostic delay has repeatedly been found to be unrelated to the stage of oral cancer at diagnosis. The aim of this study was to investigate why diagnostic delay is frequently unrelated to the stage of oral cancer at diagnosis. The odds ratio (OR) of early versus advanced oral squamous cell carcinoma was calculated for 245 consecutive patients with untreated oral squamous cell carcinoma. Being female (OR=0.40; 0.19-0.80; p<0.05) and married (OR=0.27; 0.11-0.66; p<0.01) was predictive of early stage disease. Being non-white (OR=5.42; 1.66-17.67; p<0.01) was predictive of advanced stage disease. There is no evidence that these patient demographics are associated with faster growing tumours, yet it is possible that those who are male, unmarried and non-white may not notice an oral lesion until it is advanced in stage. It is concluded that differences in tumour biology are not a likely explanation for the absence of a delay-stage relationship but instead, a proportion of tumours may be silent until advanced in stage.

Adult↗
PubMed1998

Predictors of professional diagnostic delays for upper aerodigestive tract carcinoma.

In spite of the belief that cancer mortality can be reduced if lesions are detected, diagnosed and treated at an early stage, the predictors of diagnostic delays for upper aerodigestive tract (UADT) cancers have been the subject of little research. The aim of this study was to investigate the role of selected variables as predictors of professional diagnostic delays in a sample of UADT cancer patients. Patients diagnosed with squamous cell carcinoma of oral cavity sites (ICD-9 141, 143-5) oro-, naso- and hypopharynx (ICD-9 146-8) and larynx (ICD-9 161) were included in the study. Multiple logistic regression was used to calculate the odds ratio (OR) for professional delay > 1 month versus professional delay < 1 month for selected study variables. The sample comprised 188 subjects. Multivariate analysis found that the presence of comorbidity at the time of presentation of UADT symptoms (OR 2.84; 95% CI 1.35-5.98), age > or = 65 years (OR 0.31; 95% CI 0.15-0.64), higher education (OR 0.45; 95% CI 0.22-0.93) and cancer at an oral cavity site (OR 0.31; 95% CI 0.15-0.64) were the explanatory variables for professional delay. This study suggests that, among UADT cancer patients, the presence of comorbidity at the time of presentation increases the odds for a professional delay > 1 month, while older age, higher education and oral cancer reduce the odds.

Adult↗
PubMed2001

Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia.

In-depth interviews regarding health seeking behaviour were conducted with 202 adults registered with pulmonary tuberculosis at the centralized Chest Clinic in Lusaka, Zambia. The median (mean) diagnostic delay was 8.6 (9) weeks, and was significantly associated with the following factors: female sex, lower education, more than six instances of health-seeking encounters, outpatient diagnosis of tuberculosis, and visiting a private doctor or traditional healer. More effective tuberculosis control interventions require novel methods of accessing women and less educated people. Decentralization of public tuberculosis care and improved integration with private sector health providers may also reduce diagnostic delay.

Adult↗
PubMed2005

Diagnostic delays in access to tuberculosis care in counties with or without the National Tuberculosis Control Programme in rural China.

SETTING: A county covered by the National Tuberculosis Control Programme (NTP) (Jianhu) and a nonprogramme county (Funing) in Jiangsu Province, China. OBJECTIVE: To compare diagnostic delays among tuberculosis (TB) patients between counties with and without the NTP, and to study the impact of demographic, socioeconomic and policy factors on the delays. DESIGN: A cohort study of 493 newly diagnosed TB patients registered in the study sites during 2002 was conducted using a structured questionnaire interview. RESULT: The median total diagnostic delay was longer in Jianhu County, 31 (14-68) days, compared to Funing County, 19 (12-34) days, with a shorter patient's delay (10 vs. 16 days, P < 0.05) but a longer doctor's delay (6 vs. 0 days, P < 0.01) in Jianhu than in Funing. Smear-positive TB accounted for 86% of patients in Jianhu, compared to 37% in Funing. Less educated and uninsured patients had longer patient's or doctor's delays in Jianhu, while in Funing poor patients and farmers had both longer patient's and doctor's delays. CONCLUSION: The subsidised NTP leads to a shorter patient's delay, but a longer doctor's delay, with a substantially higher proportion of smear-positive TB diagnosis. Education, medical insurance, poverty and the system of TB control can influence patients' access to TB care.

Adolescent↗
PubMed1996

[Analysis of the diagnostic delay in tuberculosis].

OBJECTIVE: To identify the situations that influence in the delayed diagnosis of tuberculosis. PATIENTS AND METHOD: We studied 109 patients (87 non HIV-infected and 22 HIV-infected) who were diagnosed of tuberculosis in one year consecutively, using a questionnaire to obtain time intervals in which the whole diagnostic delay (WD) was divided. RESULTS: WD was higher than 1 month in 90 % of non HIV-infected patients. The delay due to the health system (SD) was higher (71% > 1 month) than the delay due to patient (PD; 30% > 1 month) and there was a negative correlation between both (R-0.73). In HIV+ group, WD was lower (59.1% > month) and, although PD was higher (40.9% > 1 month), the time that the system delayed the suspicion of the diagnosis was lower (5.5% > 1 month). In HIV-group there were the following significant differences: higher delay in the suspicion of diagnosis (DSD) (61.4% and 60.8% > 1 month) and shorter time to make the diagnosis (12.3% and 21.6% > 1 month) in sputum smear-positive patients and who had cavitary lesions; PD was higher (67.1% > 1 month) in patients with general symptoms and nearly none in patients with upper airways symptoms; and higher DSD in presence of nonspecific symptoms like cough or/and expectoration (68.6% > 1 month) or upper airways symptoms (100% > 1 month). As these clinical symptoms were consulted in primary care mainly, there was a higher SD (75.75 > 1 month) and DSD (58.1% > 1 month), and were increased when a promptly chest X-ray was not performed (87.1 and 68.7% > 1 month). CONCLUSIONS: Delayed diagnosis of tuberculosis is common. In non HIV-infected patients, it occurs mainly in the health system. Diagnostic delays contribute to raise advanced disease with more contagious potential.

Adult↗
PubMedDate not supplied

The effect of diagnostic delay in patients with Hodgkin's lymphoma.

BACKGROUND: The aim of the study was to document the delay in diagnosis of Hodgkin's disease (HD) and clarify the impact on clinical stage and survival in our region. MATERIAL AND METHODS: A retrospective study of the records of 50 patients treated for primary HD in northern-Norway in the time period 1985 - 1993 was performed in November 1994. The diagnostic delay related to clinical stage, age, sex, relapse or death were registered. RESULTS: The median delay was 4 months (range 0 - 48 months). The histological subgroup lymphocyte predominance (LP) HD had a significant prolonged delay (p = 0.038). There was no correlation between delay in diagnosis and age, sex, B-symptoms, stage of disease, recurrent disease or death of disease. CONCLUSION: The diagnostic delay in patients with HD does not seem to have any significant influence on stage distribution, relapse rate or short-term survival. The aggressiveness of the tumour may be the important parameter.

Adolescent↗
PubMed2005

Travellers returning to Sweden with falciparum malaria: pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay.

We have investigated pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay in travellers returning to Sweden with falciparum malaria. Questionnaires were distributed to patients having been notified with falciparum malaria from 1994 to 2001. Of 408 notified patients, 237 (58%) returned the questionnaires; 62% were males and 43% above the age of 45 y. Africa was the travel destination in 90% of the cases, and 27% had travelled to Kenya. 69% had spent more than 1 night in the countryside, and 6% had stayed in modern urban areas only. 40% took an adequate dose of chemoprophylaxis, although this proportion decreased from 55% to 12% during the study period. Nine per cent used both bed nets and mosquito repellents regularly. The median time from onset of symptoms to contact with health care professionals was 2 d, and from that contact to start of malaria treatment the median time was less than 24 h.

Adolescent↗
PubMed1989

[Colorectal cancer: are diagnostic delay, degree of spread and survival related? Clinical analysis of 307 cases followed up for more than 4 years].

It seems logical to think that the longer the interval between the patient's first symptom of colorrectal cancer and operation, the greater the tumoral extension found by the surgeon will be, and the lower the postoperative survival. Nevertheless, there is much evidence to indicate that this may not always be true. We've analyzed the problem in 307 patients operated of colorectal cancer in our service from January 1979 to December 1984 and followed-up until now. We investigated the time interval from the first clinical symptom until operation, and survival. These variables were related to the Duke grade. As regards the preoperative interval, the average (in months) for Duke's grade A was 7.41 (sigma = 16.88), for D it was 7.41 (sigma = 9.47) and for C, 5.13 (sigma = 8.41). There were no statistically significant differences. As for survival, after four years all the grade A patients, 64% of the grade B patients and 35% of the grade C patients followed-up survived. We've found no relation between diagnostic delay and postoperative survival. These results suggest that it is not true that the longer the symptomatic period, the greater the tumoral spread. As such, diagnostic delay is not a good prognostic indicator for predecting tumoral spread or survival.

Colorectal Neoplasms↗
PubMed2005

Gender and literacy: factors related to diagnostic delay and unsuccessful treatment of tuberculosis in the mountainous area of Yemen.

SETTING: People in the mountainous area of Yemen, having maintained their traditional lifestyle, generally believe that uneducated women are unsuccessful in using modern medical care. Whether this belief applies to tuberculosis (TB) diagnosis and treatment has not been researched in Yemen. OBJECTIVE: To examine how gender and literacy influence TB diagnosis and treatment. DESIGN: Individual interviews and data collection were conducted for 74 smear-positive pulmonary TB patients visiting the National Tuberculosis Institute in Sana'a from December 2001 to March 2002. The treatment outcome for each patient was checked from September 2002 to March 2003. RESULTS: Illiterate patients had a longer diagnostic delay than literate patients (P = 0.006, univariate logistic regression analysis). They also maintained their traditional view of illness, not the illness 'TB'. More females than males completed treatment (P = 0.046, univariate logistic regression analysis). Supervision by male relatives contributed to completion of treatment among female patients. CONCLUSION: Lack of education does not hinder women from receiving TB diagnosis and treatment. The concept of traditional illness, however, causes a longer diagnostic delay among illiterate patients, and the role of male relatives positively influences treatment outcomes for female patients.

Culture↗
PubMed1999

Abdominal tuberculosis: the problem of diagnostic delay.

Abdominal tuberculosis can be difficult to diagnose. In order to minimize diagnostic delay, an audit study showed that the Mantoux test and/or culture of ascitic fluid did not reveal tuberculosis immediately. Laparoscopy/laparotomy with Ziel-Nielson staining and culture of tissue biopsy always confirmed the diagnosis. It is suggested that biopsy should be the first line in investigating patients suspected of having abdominal tuberculosis.

Adult↗
PubMedDate not supplied

[Clinical manifestations and diagnostic delay in Wolfram's syndrome].

UNLABELLED: Wolfram's syndrome (SW): diabetes mellitus (DM), diabetes insipidus (DI), blindness and deafness, is multiorganic, hereditary and uncommon. Mitochondrial dysfunction damages the oxidative pathway. OBJECTIVE: To analyze the clinical characteristics, diagnostic delay in constituent diseases and early diagnostic impact over morbidity-mortality. MATERIAL AND METHODS: Descriptive retrospective study of 23 Spanish patients with SW. Different clinical entities analysis, onset age, lapse of time before diagnosis, morbidity-mortality causes, prescribed therapy and consanguinity between parents. RESULTS: Components prevalence: DM and optic atrophy (AO), 100%; auditory impairment, 95.65%; DI, 82.6%; gonadal atrophy, 75% in men; menstrual disorders, 87.5% in women. Other diseases: urinary tract, neurologic and heart disorders. CONCLUSIONS: Most of the patients will develop almost all the complications. Juvenile DM in association with AO is its best diagnostic criteria. Early therapy should delay progression and control mortality causes.

Adolescent↗