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Published on: October 25, 2018
Factors affecting the diagnostic delay of myasthenia gravis
I R Marlet1, R K Andersen2, K H Axelsen2
1Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen, Denmark. idamarlet@hotmail.com.
Background:
Early detection and diagnosis of myasthenia gravis (MG) is important to improve the chance of remission and overall prognosis. This study aims to investigate the factors affecting the diagnostic delay of MG thereby highlighting the challenges in the diagnostic process.
Methods:
We conducted a retrospective study examining characteristics and factors involved in the diagnostic process of MG. We included 350 patients treated for MG at the Copenhagen Neuromuscular Unit (CNMC), between 1980 and 2022. A total of 315 patients had data on time to diagnosis, which was used to categorize them into an early-and a delayed diagnosis group, based on a median cut-off of 141 days. A separate analysis was conducted for the cases with an extremely delayed time to diagnosis exceeding the upper quartile range of 864 days (n = 28). Finally, change in time to MG diagnosis over time was identified.
Results:
The overall mean time to diagnosis was found to be 331 days (range: 5-4492 days). Patients who experienced a delayed diagnosis were significantly younger at onset (50.4 vs. 55.4 years, p-value < 0.05), and experienced higher frequency of asymptomatic periods (29% vs. 10%, p-value < 0.05). We found a delayed referral to specialists, extended time spent at specialists, and delayed initiation of paraclinical diagnostic tests. Additionally, in the delayed group we found extended time from the initial antibody (AB) evaluation to the first positive result (3.2 vs. 86.1 days, p-value < 0.05). Individuals in the early diagnosis group may be referred to stroke specialist earlier, however, this finding was not statistically significant (18 vs. 464 days, p-value 0.17). Gender, presenting symptom, final type of MG and socioeconomic status where not associated with delayed diagnosis. Generally, a trend of decreasing time to diagnosis over time was observed.
Conclusion:
Younger age at onset, higher prevalence of asymptomatic periods, and a delayed positive AB titer test may be risk factors for a delayed MG diagnosis. Prompt referral to a stroke specialist may lead to an earlier diagnosis.
Insights
Delayed diagnosis of myasthenia gravis (MG) is linked to younger age, asymptomatic periods, and slow antibody test results. Earlier specialist referral may improve diagnostic timelines for MG.
Area of Science:
- Neurology
- Immunology
Background:
- Myasthenia gravis (MG) diagnosis and early detection are crucial for improving patient prognosis and remission rates.
- Diagnostic delays in MG present significant challenges, impacting treatment outcomes.
Purpose of the Study:
- To investigate factors contributing to diagnostic delays in myasthenia gravis.
- To identify challenges within the myasthenia gravis diagnostic process.
Main Methods:
- Retrospective study of 350 patients diagnosed with MG between 1980 and 2022.
- Categorization into early and delayed diagnosis groups based on a 141-day median time to diagnosis.
- Analysis of factors including age, asymptomatic periods, specialist referral times, and antibody test turnaround.
Main Results:
- Mean time to diagnosis was 331 days; delayed diagnosis was associated with younger age at onset and more frequent asymptomatic periods.
- Delayed diagnosis correlated with longer specialist referral times, extended specialist consultations, and delayed paraclinical testing.
- A significant delay was observed in obtaining positive antibody (AB) test results in the delayed diagnosis group (86.1 days vs. 3.2 days).
- A trend towards decreased time to diagnosis over the study period was noted.
Conclusions:
- Younger age at onset, asymptomatic periods, and delayed antibody test results are risk factors for delayed MG diagnosis.
- Prompt referral to specialists, particularly stroke specialists, may expedite the diagnosis of myasthenia gravis.
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