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Published on: November 9, 2017
Diagnostic odyssey of Guillain-Barré syndrome in children
Yoko Kobayashi Takahashi1, Itaru Hayakawa2, Yuichi Abe3
1Division of Neurology, National Center for Child Health and Development, Tokyo, Japan; Department of Child Neurology, National Center for Neurology and Psychiatry, Tokyo, Japan.
Insights
Pediatric Guillain-Barré syndrome (GBS) diagnosis is challenging. This study reveals a 9-day diagnostic delay, with physician-related delays and misdiagnoses significantly impacting children with GBS.
Area of Science:
- Pediatric Neurology
- Clinical Diagnostics
- Rare Diseases
Background:
- Pediatric Guillain-Barré syndrome (GBS) presents diagnostic challenges, hindering timely intervention.
- Early recognition and treatment are crucial for favorable outcomes in pediatric GBS.
Purpose of the Study:
- To create a diagnostic odyssey plot for pediatric GBS.
- To analyze diagnostic delays, physician-related delays, patient-related delays, and diagnostic errors.
Main Methods:
- Retrospective cohort study of pediatric GBS patients (2003-2020).
- Analysis of overall diagnostic delay, physician-related delay, and patient-related delay.
- Evaluation of misdiagnosis frequency and associated risk factors.
Main Results:
- 21 pediatric GBS patients studied; 17 experienced 40 misdiagnoses.
- Median overall diagnostic delay was 9 days (IQR, 6-17 days).
- Physician-related delays, but not patient-related delays, correlated with overall delay. Risk factors included delayed symptoms and misdiagnosis as infections or orthopedic issues.
Conclusions:
- Pediatric GBS has a distinct diagnostic odyssey.
- Clinical factors like symptom presentation and initial misdiagnosis significantly contribute to diagnostic delays.
Background And Objectives:
A gap exists between difficulty in diagnosis and importance of early recognition and intervention in pediatric Guillain-Barré syndrome (GBS). Therefore, this study aimed to establish a diagnostic odyssey plot that allows "at-a-glance" overview of the diagnostic odyssey of GBS in children, including overall diagnostic delay, physician-related and patient-related diagnostic delays, and length and frequency of diagnostic errors.
Methods:
In this single-center retrospective cohort study, standardized data were obtained from children with GBS from 2003 to 2020. Overall diagnostic delay (time between symptom onset and diagnosis), physician-related diagnostic delay (time between the first medical visit and diagnosis), and patient-related diagnostic delay (time between symptom onset and the first medical visit) were analyzed.
Results:
The study examined a total of 21 patients (11 men, median age 4.5 years). Overall, there were 40 misdiagnoses among 17 patients, while four were diagnosed correctly at the first visit. The overall diagnostic delay was 9 days [interquartile range (IQR), 6-17 days]. Physician-related diagnostic delay, but not patient-related diagnostic delay, was correlated with the overall diagnostic delay. Patients in the late-diagnosed group were more frequently misdiagnosed during their diagnostic odyssey than patients in the other groups. Risk factors associated with diagnostic delay included delayed onset of weakness and sensory deficits, absence of swallowing problems, and misdiagnosis as orthopedic disorders or viral infections.
Discussion:
A unique diagnostic odyssey exists in pedaitric GBS. Several clinical risk factors were associated with the diagnostic delay.
