Effect of delayed diagnosis on severity of Pott's disease

Eli Kamara, Sahil Mehta, James C.M. Brust, Anil K. Jain

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)245-254
Number of pages10
JournalInternational Orthopaedics
Volume36
Issue number2
DOIs
StatePublished - Feb 2012

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Spinal Tuberculosis
Delayed Diagnosis
Confidence Intervals
Tuberculosis
Odds Ratio
Back Pain
Islam
Abscess
India
Fever
Magnetic Resonance Spectroscopy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Effect of delayed diagnosis on severity of Pott's disease. / Kamara, Eli; Mehta, Sahil; Brust, James C.M.; Jain, Anil K.

In: International Orthopaedics, Vol. 36, No. 2, 02.2012, p. 245-254.

Research output: Contribution to journalArticle

Kamara, Eli ; Mehta, Sahil ; Brust, James C.M. ; Jain, Anil K. / Effect of delayed diagnosis on severity of Pott's disease. In: International Orthopaedics. 2012 ; Vol. 36, No. 2. pp. 245-254.
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abstract = "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.",
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