Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database.
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Osteomyelitis of the scapula with secondary septic arthritis of the shoulder joint.
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We report a delayed diagnosis of osteomyelitis of the scapula involving the inferior angle and extending to the glenoid, with secondary septic arthritis of the glenohumeral joint in a 7-month-old female infant. The patient was treated with arthrotomy of the shoulder joint, anterior drainage of pus and intravenous antibiotics. The diagnosis was delayed as the patient was found to have bilateral lung abscess and other foci of infection, for which she was treated in the neonatal intensive care unit, with all the medical efforts directed towards saving her life. The diagnosis of septic shoulder arthritis is uncommon and difficult, requiring a high index of suspicion, which was another reason for the delayed diagnosis. (+info)
Combining area-based and individual-level data in the geostatistical mapping of late-stage cancer incidence.
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Slipped upper femoral epiphysis in children--delays to diagnosis.
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BACKGROUND: Slipped upper femoral epiphysis (SUFE) is a childhood condition requiring urgent admission for surgery. It is often complicated by delayed diagnosis. METHOD: This study investigated incidence and factors contributing to delayed diagnosis of SUFE, by retrospective and prospective review of children (n=120) presenting to a tertiary institution with SUFE from 2003-2007. RESULTS: The delay from initial presentation to a health professional to hospital admission ranged from 0-731 days. Most patients (76%) presented initially to their general practitioner. Of children with stable SUFE, the diagnosis was missed at the initial consultation in 62 (60%) of 103 children, and there was a delay after X-ray to diagnosis of 0-11 days. There were no delays from hip radiograph to confirmation in patients with unstable SUFE. DISCUSSION: A child presenting with hip, thigh or knee pain and reduced hip range of movement (particularly internal rotation) on the affected side, should arouse clinical suspicion of SUFE. This should prompt radiographic imaging of the hip with antero-posterior and lateral hip views. This study shows that most children presenting to The Royal Children's Hospital (Melbourne, Victoria) with SUFE from 2003-2007 presented first to their GP and some faced significant delays to diagnosis and admission. These delays are of concern as delays have been shown to result in increased severity of physeal slip and poorer long term outcomes. General practitioners play a crucial role in the early recognition and diagnosis of SUFE to ensure timely and appropriate referral and the best possible outcome for the child. (+info)
Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions.
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Considerable delay in diagnosis and acute management of subarachnoid haemorrhage.
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INTRODUCTION: Rebleeding from subarachnoid haemorrhage (SAH) usually occurs within the first six hours after the initial bleeding. Rebleeding can be prevented effectively with tranexamic acid (TXA). Although a broad consensus has evolved that SAH should be treated as an emergency, it is likely that delays do exist in the diagnosis and treatment of SAH patients. The aim of this study was to prospectively assess the interval between symptom onset, emergency room (ER) admission, initial diagnosis and treatment, and final closure of the aneurysm. MATERIAL AND METHODS: We prospectively studied the time course from the initial bleeding to ER admission, computed tomography (CT), TXA treatment, referral to the neurosurgical department, and to the final closure of the aneurysm. RESULTS: A total of 133 patients with SAH due to ruptured intracranial aneurysms were admitted to two neurosurgical units in Copenhagen, Denmark, during a one-year period. The median time to admission was 60 min. The median delay from admission to CT scan was 55 min. Long pre-hospital delay (p = 0.03) and high Glasgow Coma Scale score on arrival (p = 0.0006) were associated with a longer time to CT scan. The median time from CT scan to initiation of TXA treatment was 50 min. The median time from initial insult to final closure of the aneurysm was 30 hours. CONCLUSION: The present study demonstrates that considerable diagnostic delays exist in connection with CT and TXA treatment after patients' arrival to the ER. (+info)
The interface of primary and oncology specialty care: from symptoms to diagnosis.
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