TY - JOUR
T1 - Effect of delayed diagnosis on severity of Pott's disease
AU - Kamara, Eli
AU - Mehta, Sahil
AU - Brust, James C.M.
AU - Jain, Anil K.
N1 - Funding Information:
Acknowledgements The authors thank Drs. S.M. Tuli, Oheneba Boachie, Rick Hodes and Ellie Schoenbaum for their guidance in the development of this project, Drs. D. Prabhakaran, N. Tandon, V. Narayan and M. Ali for their support throughout the project, the Center for Chronic Disease Control in New Delhi, and Meredith Blevins for her biostatics consultations. JCMB is supported by the National Institutes of Health (K23 AI083088). This work was supported by the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental and Craniofacial Research, National Institute On Drug Abuse, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, and National Institutes of Health Office of Women’s Health and Research through the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University (R24 TW007988) and the American Relief and Recovery Act.
Funding Information:
Study participants were enrolled between January and June 2011 from two tertiary-care hospitals (one private – VIM-HANS hospital, one public – Guru Teg Bahadur) in New Delhi, India. Patients who had been diagnosed with vertebral TB either clinicoradiologically, or pathologically via polymerase chain reaction (PCR), culture or histology, and who could provide their diagnostic imaging were invited to participate. Patients were recruited from inpatient wards, outpatient clinics, and TB clinics. All had either initiated or were planning to initiate antituberculosis therapy during the study period. The institutional review boards of the University College of Medical Sciences, Public Health Foundation of India, and Emory University approved the study. All participants provided written informed consent.
PY - 2012/2
Y1 - 2012/2
N2 - Purpose: We analysed delay in diagnosis (DID) and disease severity in patients with vertebral tuberculosis (TB) in India. Methods: We interviewed 228 patients with vertebral TB and reviewed their diagnostic magnetic resonance images (MRIs). We examined patient characteristics at the time of presentation and associations between socioeconomic background, access to care, DID and radiographic disease severity at the time of diagnosis. Results: The most common presenting symptom was localised back pain (84%), followed by fever (40%) and pain elsewhere (28%). The median DID was five months [interquartile range (IQR) 3-9]. In multivariate logistic regression, Muslim and older patients had a higher risk of extreme (more than ten months) DID [adjusted odds ratio (aOR) 2.91; 95% confidence interval (CI) 1.20-7.08 and 2.33; 95% CI 1.23-4.94, respectively]. One hundred and two patients (64%) had vertebral abscesses. Median local kyphotic deformity was 11.7° (IQR 0-18.5°). Fifty-four (34%) patients had radiologically severe disease at the time of diagnosis. Older patients and those with higher education were less likely to have severe disease at the time of diagnosis (aOR 0.32; 95% CI 0.13-0.76 and 0.20 95% CI 0.06-0.62, respectively). Patients who experienced extreme DID were more likely to have severe disease (aOR 2.67; 95% CI 1.05-6.99). Conclusions: Most patients in this cohort experienced long delays in diagnosis, and such delay was significantly associated with the presence of severe disease. Clinicians in TB-endemic areas must consider vertebral TB early and obtain imaging in patients who complain of persistent back pain. Improved diagnostic criteria are needed to identify patients at higher risk of disease.
AB - Purpose: We analysed delay in diagnosis (DID) and disease severity in patients with vertebral tuberculosis (TB) in India. Methods: We interviewed 228 patients with vertebral TB and reviewed their diagnostic magnetic resonance images (MRIs). We examined patient characteristics at the time of presentation and associations between socioeconomic background, access to care, DID and radiographic disease severity at the time of diagnosis. Results: The most common presenting symptom was localised back pain (84%), followed by fever (40%) and pain elsewhere (28%). The median DID was five months [interquartile range (IQR) 3-9]. In multivariate logistic regression, Muslim and older patients had a higher risk of extreme (more than ten months) DID [adjusted odds ratio (aOR) 2.91; 95% confidence interval (CI) 1.20-7.08 and 2.33; 95% CI 1.23-4.94, respectively]. One hundred and two patients (64%) had vertebral abscesses. Median local kyphotic deformity was 11.7° (IQR 0-18.5°). Fifty-four (34%) patients had radiologically severe disease at the time of diagnosis. Older patients and those with higher education were less likely to have severe disease at the time of diagnosis (aOR 0.32; 95% CI 0.13-0.76 and 0.20 95% CI 0.06-0.62, respectively). Patients who experienced extreme DID were more likely to have severe disease (aOR 2.67; 95% CI 1.05-6.99). Conclusions: Most patients in this cohort experienced long delays in diagnosis, and such delay was significantly associated with the presence of severe disease. Clinicians in TB-endemic areas must consider vertebral TB early and obtain imaging in patients who complain of persistent back pain. Improved diagnostic criteria are needed to identify patients at higher risk of disease.
UR - http://www.scopus.com/inward/record.url?scp=84859159000&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859159000&partnerID=8YFLogxK
U2 - 10.1007/s00264-011-1432-2
DO - 10.1007/s00264-011-1432-2
M3 - Article
C2 - 22215363
AN - SCOPUS:84859159000
SN - 0341-2695
VL - 36
SP - 245
EP - 254
JO - International Orthopaedics
JF - International Orthopaedics
IS - 2
ER -
