SEARCH · PubMed Health

Results for “Delayed Diagnosis”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed1996

Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation?

Blast injuries are rare, and although blast-induced perforations of the bowel have been described in the past, the entity of a delayed perforation caused by an evolving injury has not been reported. We report three men injured by the explosion of a terrorist bombing in open air. They suffered primary blast injuries, which resulted in isolated perforations of the terminal ileum. They were operated at different times after the blast event. The resected specimens were examined under light microscopy. One patient was operated immediately, and had three perforations in the terminal ileum. In the other two patients, abdominal complaints appeared only 24 and 48 hours later. These two patients were found to have hematomas in the wall of the terminal ileum, and small perforations therein, with almost no contamination of the peritoneal cavity. On histological examination, there were small perforations with disruption of all intestinal layers. In the vicinity of the perforations, the mucosa was necrotic and disorganized. The submucosa showed edema and vascular thrombi, and at several points mucus was shown dissecting through the muscularis propria, thus creating minute microperforations. Because of the findings in these patients, we suggest a mechanism of evolving damage to the bowel wall and delayed perforation rather than delayed diagnosis, after blast injuries. We suggest that patients exposed to a significant blast should be watched carefully for at least 48 hours.

Adolescent↗

PubMed1999

[Age at disease onset and delayed diagnosis of spondyloarthropathies].

A questionnaire with 78 questions concerning the situation of ankylosing spondylitis (AS) sufferers in Germany was distributed to a representative 3000 out of the more than 14,000 patient members of the German AS society; 1614 patients (54%) responded. The age distribution of these patients roughly agrees with that expected due to the distribution of the age at diagnosis and the age distribution of the German population. The group of patients more than 65 years old is, however, under-represented. It turned out that at least 28% of the patients responding do not suffer from idiopathic AS but from other spondyloarthritides (spondylitic psoriasis, spondyloarthritis combined with Crohn's disease or ulcerative colitis). The distribution of the age at disease onset agrees well with that published in 1984 by van der Linden et al.: For 4% of the patients, the age at appearance of the first spondylitic symptoms was less than 15 years, for 90% it was 15-40 years and for the remaining 6% more than 40 years. The average age at disease onset was 25.6 years. The spondyloarthritides do not differ significantly in the distribution of the age at the first spondylitic symptoms. The distribution of the age at diagnosis did not differ significantly between male and female patients, in contrast to the findings by van der Linden et al. in 1984. The average age at diagnosis was 34.3 and 35.3 years for male and female patients, respectively. The resulting mean diagnosis delay for male and female patients was 8.4 and 9.8 years, respectively. Whereas the average diagnosis delay was still 15 years for patients with disease onset in the 1950s, it was only 71/2 years for patients with disease onset in 1975-79. It is not yet possible to predict if an average diagnosis delay less than 71/2 years results for patients with a disease onset later than 1980, because the number of further diagnoses to be expected for patients with disease onset in these years is not negligible. Twenty-six percent of the patients (22% of the males, 34% of the females) have relatives, likewise, suffering from AS. Whereas patients with familiar AS experience their first spondylitic symptoms, in the average, 11/2 years earlier than patients without relatives suffering from AS, the difference is 5 years for patients suffering from spondyloarthritis combined with ulcerative colitis. Reports written for patients on other results of the survey can be found in the newsletter "Bechterew-Brief" of the Deutsche Vereinigung Morbus Bechterew.

Adolescent↗

PubMed1999

Factors contributing to delayed diagnosis in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) can be difficult to diagnose. Not only is the post-nasal space (PNS) inaccessible to examination, it is frequently occupied by normal lympho-epithelium which can make differentiation from NPC difficult. Together with its frequent atypical presentation, it is not surprising that the diagnosis is missed or delayed. This is undesirable as the treatment of early NPC carries an excellent prognosis. The aim of this study is to ascertain the extent of the problem of missed or delayed diagnosis and to study the factors responsible. This was a retrospective study of all newly diagnosed patients with NPC from the Singapore General Hospital and treated in the Department of Therapeutic Radiology in the year 1996 (1 January-31 December). A total of 126 patients were studied. Eighteen patients (14.3 per cent) were found to have delayed diagnosis of more than a month. The delay ranged from 1.2 to 25 months (mean 7.2 months). Factors identified which contributed to delayed diagnosis included i) Clinicians not considering a diagnosis of NPC ii) Clinicians suspecting NPC but misled by the results of investigations iii) Patients refusing investigation or defaulting follow-up. Nearly a fifth of patients with NPC had delayed diagnosis. Many of the factors responsible for the delays appear to be preventable by better patient education and counselling, doctors having sharper clinical acumen and skills in NPC diagnosis and the hospital administration having a system of tracking down high risk patients who default.

Clinical Competence↗

PubMed1991

Delayed diagnosis in subarachnoid haemorrhage.

OBJECTIVE: To determine the outcome in patients with subarachnoid haemorrhage from a ruptured aneurysm, particularly in those in whom the diagnosis was delayed. DESIGN: A two-year retrospective study of medical records of patients admitted to Westmead Hospital between July 1988 and June 1989. SETTING: A tertiary level teaching hospital. PATIENTS: Ninety-four patients treated for subarachnoid haemorrhage. In 15 cases the diagnosis was delayed. MAIN OUTCOME MEASURES: Death, disability, or functional recovery. RESULTS: Overall, 40 (42.5%) patients died, 14 (15%) were disabled, and 40 made a functional recovery. Of the 62 patients who were treated surgically 38 (61%) made a functional recovery compared with two of the 32 (6%) who were not. Of the 15 in whom the diagnosis was delayed seven (47%) made a functional recovery. Confirmation of the diagnosis was delayed in four of the latter group because a cranial computed tomography scan showed no abnormalities. CONCLUSIONS: Earlier diagnosis, allowing early definitive surgical treatment, may improve the outcome in aneurysmal subarachnoid haemorrhage. The results of a computed tomography scan are diagnostic only if they are positive--a negative result must be interpreted in conjunction with the clinical picture.

Acute Disease↗

PubMed1999

Delayed diagnosis of cancer with emphasis on oral cavity cancers.

Delayed diagnosis of cancer and, of oral cavity cancers in particular, is of crucial importance for the clinical management, costs of care and unfavourable outcome. Many scientists have studied the causes of delayed diagnosis to find solution of the problem. However, only few studies of this kind have been performed in Bulgaria, especially for oral cavity cancers. The aim of this overview was to summarize and analyze publications on problems and causes of delayed diagnosis of cancer in general and, of oral cavity cancers in particular. The literature search was made in different databases such as MEDLINE, BIOSIS, INTERNET, etc. More than 100 relevant items of information were extracted but only 22 of them were found suitable and further analyzed. The analysis of the literature has revealed the importance of recognizing the warning signals and causes of delayed diagnosis in cancer in general and in oral cavity cancers in particular. For instance, survival of patients with squamous cell carcinoma of the tongue (Dx:141) was related to delayed diagnosis (20% of patients survive more than 5 years and 71%--only 2 years after diagnosis). The problems of delayed diagnosis in patients with multiple neoplasm of the oral cavity (Dx:143-145) and with nasopharyngeal carcinoma (Dx:146-149) were also discussed (96.6% of patients were in stage III at diagnosis). This overview has summarized problems in and stressed the main aspects of delayed diagnosis of cancer in general. It has also denoted hints in delayed diagnosis of cancer of the oral cavity and their relevance to the clinical management, outcome and costs of care for such patients. The latter has been considered of primary importance for general practitioners, dentists and specialists in public health medicine.

Bulgaria↗

PubMedDate not supplied

Metastatic penile cancer in a young Caucasian male: impact of delayed diagnosis.

Penile cancer is an uncommon malignancy in the developed world, with only 1200 estimated cases per year in the United States. This is usually a cancer of older men and often the diagnosis is delayed because of lack of suspicion on the part of the patient or primary care provider. We report a case of penile cancer in a young Caucasian male in whom a delay in diagnosis had a deleterious impact on outcome. We describe and illustrate how, to palliate his symptoms, the patient required a hemipelvectomy plus a total pelvic exenteration. We present this case to alert physicians of the possibility of penile cancer in young Caucasian males as well as to demonstrate the significant morbidity and mortality that can ensue from a delay in diagnosis.

Adult↗

PubMed1988

Congenital adrenal hyperplasia in females with virilized genitalia: the problem of delayed diagnosis.

Six girls with the non-salt-losing form of congenital adrenal hyperplasia are described. Diagnosis was delayed in five, the range of ages of diagnosis being 19 months-7 years. In the sixth, despite early diagnosis and medical treatment, surgery was delayed electively until she was 3 years old. The five in whom diagnosis was delayed were all virilized with a markedly advanced bone age and reduced adult height prognosis. Diagnosis was delayed for a variety of reasons: misinterpretation of laboratory data (one), lack of availability of medical assistance (one), language problems (one), maternal inexperience (one), and failure of the doctor to recognize an obvious clinical abnormality (one). All six children came from immigrant families, and all except one was born in a major centre. None was born before 1979.

Adrenal Hyperplasia, Congenital↗

PubMed1992

Delayed diagnosis of juvenile myoclonic epilepsy.

Fifteen cases of juvenile myoclonic epilepsy (JME) were identified from one hundred and eighty consecutive patients referred to a new epilepsy clinic at St Thomas' Hospital between April 1989 and December 1990, a prevalence of 8.3%. Of these, only one was referred with a putative diagnosis of JME. Diagnosis of the other patients on referral included "epilepsy", "grand mal", "temporal lobe epilepsy", "photoconvulsive epilepsy" and "alcohol-induced epilepsy". At least 11 of the 15 patients had been seen by a neurologist in the United Kingdom before referral. Definitive diagnosis was delayed by a mean of 14.5 years. In seven patients inappropriate anticonvulsants had been prescribed. Control of seizures was improved in most patients after diagnosis. Factors responsible for the delay in diagnosis include lack of familiarity with the syndrome, failure to elicit a history of myoclonic jerking and high prevalence of focal abnormalities on the EEG. Precipitation of fits by alcohol and sleep deprivation may not be recognised by the physician as part of the syndrome of JME. Diagnosis may also be delayed in patients whose absence and generalised tonic-clonic seizures pre-date myoclonic jerks.

Adolescent↗

PubMed2000

Implications of delayed diagnosis in colorectal cancer.

BACKGROUND: Delayed diagnosis of colorectal cancer (CRC) continues to produce anxiety and is associated with the assumption that disease stage and survival will be worse. The aims of the present study were to assess the prevalence and reasons for delay in the diagnosis of CRC, and the effects of delay, gender, age and tumour site on the stage of disease. METHODS: A retrospective study of 100 patients presenting with CRC during a 1-year period was performed. Delay was defined to have occurred if more than a 3-month period had lapsed from the time when initial symptoms were clearly established to the time of operation. Data were collected on principal presenting symptoms, time to first presentation to a doctor, time to diagnosis and treatment, reasons for delay, diagnostic procedures, tumour site, operation, and Australian clinicopathological (ACP) stage of the tumour. RESULTS: Thirty-four patients had a delay in diagnosis of their cancer. In 18 patients (53%) delay was attributable to patient reasons; in 13 patients (38%) delay was attributable to doctor-related delay and in three patients (9%) it was attributable to both. Male patients were more likely to have patient-related delay (31% for male patients vs 10% for female patients; P = 0.011). Patients with delay were less likely to have a stage A tumour (6% for delay group vs 21% for non-delay group; P = 0.04). Male patients were less likely to have a stage A tumour than female patients (8% for male patients vs 25% for female patients; P = 0.018), but the effect of delay on stage disappeared when gender and tumour site were controlled in a logistic regression model. CONCLUSIONS: The present study suggests some areas where improvements may be made concerning early diagnosis and treatment of patients with CRC.

Adult↗

PubMed2002

Overall clinical breast examination as a factor in delayed diagnosis of breast cancer.

HYPOTHESIS: A standardized description of clinical breast examination (CBE) can predict the risk of delayed diagnosis of breast cancer. DESIGN: Survey of case series. SETTING: Breast surgery referral practice. PATIENTS: Consecutive sample of 371 women with 386 breast cancers of any stage for whom overall characteristics of CBE were recorded at the initial consultation. INTERVENTION: None. MAIN OUTCOME MEASURES: Overall breast "durity" (from Latin duritia, meaning "hardness") was recorded as the inverse of whether rib edges could be felt through breast tissue in the most "dur" (firm or hard) part of the breast, usually the upper outer quadrant adjacent to the areola. "Nodularity" was recorded in this same area by means of an ordinal scale ranging from "surface is smooth" to "coarse nodularity." Delayed diagnosis was tabulated if the patient was told that cancer was not present when there was a sign of cancer on CBE, mammogram, and/or pathology slides. Relative risk of delayed diagnosis was determined within categories of nodularity or durity and within nodularity and durity categories combined. RESULTS: Diagnosis was delayed for 35 (9.1%) of cancers. Delay was least common (2 [2.2%] of 92) for less dur and less nodular breasts (relative risk, 1.0), most common (18 [13.5%] of 133) for less dur and more nodular breasts (relative risk, 6.23; 95% confidence interval, 3.58-10.22), and intermediate for other descriptions (chi(2) = 9.08; P =.03). Neither nodularity alone nor durity alone correlated with delay. CONCLUSIONS: A standardized system to describe CBE will alert physicians to an increased risk of delayed diagnosis of breast cancer (especially for women with less dur and more nodular breasts), help improve interpretation of CBE, and reduce delayed diagnosis of breast cancer.

Biopsy↗

PubMedDate not supplied

Diagnosis delay in familial Mediterranean fever (FMF): social and gender gaps disclosed.

OBJECTIVE: To characterize the factors contributing to a greater than 10 year delay in the diagnosis of familial Mediterranean fever (FMF). METHODS: 50 patients, in whom diagnosis of FMF was delayed by more than 10 years, comprised the study population. The clinical, demographic and molecular genetic characteristics were compared to a control group of 50 FMF patients, in whom the diagnosis was made within a reasonable time period (less than 5 years from onset). Additional factors contributing to a delayed diagnosis in the study group, including physician-related factors, patient-related factors, disease-factors and other factors, were studied as well. RESULTS: Overall, attack sites, duration and severity were comparable among study and control groups. No differences in ethnic origin or family history of FMF were noted between the groups. There were significantly more females (p = 0.009), newly-arrived immigrants (p = 0.005) and carriers of unidentified MEFV mutations (p = 0.04) in the study group. Delayed diagnosis of FMF stemmed from misdiagnosis and physician negligence (70%), as well as from patient negligence (70%). The diagnosis was ultimately made mainly due to a change in disease pattern and other causes, such as diagnosis of FMF in a relative. CONCLUSION: The study unveils unexpected causes behind a prolonged delay in the diagnosis of FMF such as social status (immigrant), female gender, physician negligence and lack of patient awareness. The possibility that the delay stems from a milder disease pattern was dismissed.

Adult↗

PubMed1999

Risk factors of delayed diagnosis of pancreatic trauma.

OBJECTIVE: To identify risk factors associated with delayed diagnosis of pancreatic injuries. DESIGN: Retrospective study. SETTING: University hospital, Finland. PATIENTS: 31 patients treated for pancreatic injuries from January 1986 to April 1998. INTERVENTIONS: Clinical, laboratory, and radiological assessment. Initial management operative (n = 22) and non-operative (n = 9). MAIN OUTCOME MEASURES: Timely or delayed (>12 hours after injury) recognition of pancreatic trauma. RESULTS: Blunt trauma (7/17 timely and 12/14 delayed diagnosis, p = 0.03), intoxication on admission (4/10 compared with 5/5 patients studied, p < 0.05), low New Injury Severity Score (median, interquartile 34, 11.5-41 compared with 14.5, 10-25, p = 0.02), low Abdominal Trauma Index (38, 20-54 compared with 16.5 15-24, p = 0.01), absence of associated abdominal organ injuries (1/17 compared with 8/14, p = 0.004), and initial nonoperative management (2/17 compared with 7/14, p = 0.04) were significant risk factors of delayed diagnosis of pancreatic trauma. The main reasons for the delay in diagnosis were missed pancreatic injury at initial operation (n = 4, 2 penetrating), failure to exclude blunt pancreatic injury before non-operative management (n = 4), delay in presentation (n = 3), underestimation of the severity of pancreatic injury on initial computed tomogram (n = 2), and missed diagnosis of blunt duodenal rupture with mild pancreatic injury (n = 1). CONCLUSIONS: In patients with blunt abdominal trauma and altered consciousness with few clinical signs, and no or mild associated abdominal injuries, we recommend additional diagnostic studies to exclude pancreatic rupture before starting non-operative management. Exposure and evaluation of the pancreas during laparotomy for trauma is essential.

Abdominal Injuries↗

PubMed2000

[Delayed diagnosis of odontoid fracture after whiplash trauma of the cervical spine].

Fractures of the odontoid process represent about 10-20% of all diagnosed cervical spine fractures. Approximately 35% of these fractures are classified as Type II according to Anderson and D'Alonzo. They can be potentially unstable especially if combined with a dens displacement of over 6 mm. In severe cervical spine trauma, these fractures do not usually cause difficulties in diagnosis. However, in whiplash injuries, which are very common and only rarely associated with such fractures, the surgical management can be complicated if they are underestimated. These patients can present without significant neurological deficits or the situation can be complicated due to intoxication or additional trauma. Under these circumstances in particular, the diagnosis can be delayed or missed, if no strict protocols for diagnostic effort in all whiplash injuries are employed. A case of delayed diagnosis of an odontoid fracture in a neurological asymptomatic patient after whiplash injury is presented.

Adult↗

PubMed2002

Destructive osteoarthritis after delayed diagnosis of tuberculosis.

Osteoarticular tuberculosis rarely occurs in developed countries. Initial symptoms are often overlooked and the diagnosis is frequently delayed for several months. Thus, despite available diagnostic tools and accessible treatment, destruction of affected joints remains a complication of non-vertebral osteoarticular tuberculosis even in industrialized countries. We report a patient from Cleveland, Ohio, USA, in whom the delayed diagnosis of tuberculous osteoarthritis led to severe destruction of the left knee and finally, after superinfection with Staphylococcus aureus, to an above-the-knee amputation. The epidemiology, presentation, diagnosis and treatment of nonvertebral tuberculous osteoarthritis are discussed.

Aged↗

PubMed2001

Delayed diagnosis in pediatric blunt trauma.

OBJECTIVE: Identification of injuries of a traumatized patient is a mandate for the emergency department (ED) and the trauma team. Delayed diagnosis of injury in trauma patients leads to increased morbidity, mortality, dissatisfaction, and risk of litigation. Comparing children admitted for blunt trauma, with and without delay, this study examines risk factors for delayed diagnosis. METHODS: Delays in diagnosis from 1991 to 1996 were identified during prospective collection of trauma registry data. Controls were randomly selected from the trauma registry. Charts from both groups were retrospectively reviewed. RESULTS: Fifty-eight patients had 65 delays in diagnosis. Significant independent delay variables included: female, motor vehicle crash (MVC)-related mechanism, altered consciousness, higher injury severity score, and multiple injuries (P < 0.05). Trauma team activation, documentation of tertiary survey, and length of hospitalization were greater in patients with delay injuries (P < 0.05). Logistic regression identified MVC-related mechanism, female, facial, and extremity injuries as a combination of predictors. CONCLUSIONS: Delays occurred in 1% of patients. Trauma team care itself did not protect all patients from delay. Injury severity at presentation alone is not an adequate predictor of delayed diagnosis in the pediatric patient. A combination of variables was identified as negative predictors of delay. Further study is needed to validate these criteria, and determine if earlier diagnosis would effect quality.

Academic Medical Centers↗

PubMed1995

Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes.

Two analyses of patient delay in seeking a medical diagnosis are considered. In the first, a model of delay is presented. Specifically, delay is comprised of four stages (appraisal, illness, behavioural and scheduling delay intervals), each governed by a conceptually distinct set of decisional and appraisal processes beginning with the initial day that an unexplained symptom is detected to the day the individual appears before a physician. The second analysis is a social psychological one of the attributions individuals draw when relating their symptoms to their expectations and knowledge about physiological bodily processes. The eight principles of Psychophysiological Comparison Theory (PCT) provide the basis for clarifying the psychological processes of symptom interpretation and appraisal. Two studies were conducted with women seeking diagnostic evaluations for prevalent cancers: breast or gynaecological tumours. Regarding the delay model, results indicated that the delay intervals were independent (i.e. uncorrelated). Also, appraisal delay constituted the majority (at least 60 per cent) of the total delay. In the test of PCT, support was found across measures of symptoms, the context in which the symptoms arose, and the inferences people made about the symptoms.

Adolescent↗

PubMed1991

[Clinical features of delayed diagnosis in congenital duodenal obstruction].

Delayed diagnosis in two cases of congenital duodenal obstruction was discussed. Case 1. Ten-month-old baby girl with Down's syndrome was admitted to the hospital because of vomiting of milk. Wall-like obstruction was found in the second part of duodenum. Case 2. One-year-old boy infant with Down's syndrome showed a stack of coin in the duodenum on admission. Wall-like obstruction was found in the second part of duodenum. Diagnosis of duodenal obstruction is sometimes delayed in Down's syndrome. Symptom such as vomiting and growth retardation might be ignored in a child with Down's syndrome. A large hole was found in the center of the obstruction in both cases; 4 mm in diameter in case 1, 3 mm in case 2. Papilla of Vater opened at the anal side of the obstruction. These structural particularities played a role in making symptom of duodenal obstruction obscure. Mural obstruction of duodenum was observed in both cases. The obstructions were, in shape, similar to the membraneous stenosis of the duodenum. However, they were not membranes but walls as thick as 4-5 mm. Wall-like duodenal obstruction has not been reported in the literature. It can not be concluded whether mural obstruction in our cases is a new subtype of duodenal obstruction or not.

Down Syndrome↗

PubMed1995

Unusual presentations of anti-glomerular basement membrane antibody mediated disease are associated with delayed diagnosis and poor outcome.

Anti-glomerular basement membrane antibody mediated disease (anti-GBM disease) is an uncommon cause of renal failure. Presentation is usually dramatic, with renal failure and alveolar hemorrhage leading to an early diagnosis. In contrast, we here describe 3 cases which presented with atypical features, and where diagnosis was delayed due to the presence of other factors which were initially felt sufficient to explain the clinical status. No patient recovered renal function, and one died from sepsis. We also present data on 15 patients presenting to Guy's Hospital over the past 10 years with anti-GBM disease and creatinine > 500 mumol/l. The median delay from presentation to diagnosis was 7 days, range 1-81 days. Two patients died, and only one recovered renal function. We speculate that earlier referral and renal biopsy might have improved outcome in these patients, and recommend a policy of early biopsy in all cases of acute renal failure with atypical feature, delay in recovery, or where a clearcut cause is not established.

Aged↗