Koshiaris Constantinos, Oke Jason, Abel Lucy, Nicholson Brian D, Ramasamy Karthik, Van den Bruel Ann
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
BMJ Open. 2018 Jun 22;8(6):e019758. doi: 10.1136/bmjopen-2017-019758.
To quantify the duration of each step of the diagnostic pathway for patients with multiple myeloma from symptom onset to confirmation of diagnosis.
Systematic review and meta-analysis.
The MEDLINE and Embase databases were searched up until January 2018 to identify articles that reported time intervals from onset of symptoms to diagnosis. Articles focusing on children or adolescents and on the asymptomatic form of the disease (monoclonal gammopathies and smouldering myeloma) were excluded.
Data were extracted independently by two reviewers. Weighted estimates of the median and IQR were calculated. Risk of bias was assessed using the Aarhus checklist.
Nine studies were included. The patient interval (first symptom to first presentation) had a median of 26.3 days (IQR: 1-98, n=465, two studies). Subsequently, the primary care interval (first presentation to first referral) was 21.6 days (IQR: 4.6-55.8, n=326, two studies), the diagnostic interval (first presentation to diagnosis) was 108.6 days (IQR: 33.3-241.7, n=5395, seven studies) and the time to diagnosis (first symptom to diagnosis) interval was 163 days (IQR: 84-306, n=341, one study). No studies reported data for the referral to diagnosis interval.
The review demonstrates that there is scope for significant reductions in the time to myeloma diagnosis. At present, many patients experience a diagnostic interval longer than 3 months until diagnosis is confirmed.
Not available. Protocol available in the appendix.
量化多发性骨髓瘤患者从症状出现到确诊的诊断流程中每个步骤的持续时间。
系统评价和荟萃分析。
检索MEDLINE和Embase数据库至2018年1月，以识别报告从症状出现到诊断的时间间隔的文章。排除关注儿童或青少年以及疾病无症状形式（单克隆丙种球蛋白病和冒烟型骨髓瘤）的文章。
由两名审阅者独立提取数据。计算中位数和四分位间距的加权估计值。使用奥胡斯清单评估偏倚风险。
纳入9项研究。患者间隔（首次症状到首次就诊）中位数为26.3天（四分位间距：1 - 98，n = 465，两项研究）。随后，初级保健间隔（首次就诊到首次转诊）为21.6天（四分位间距：4.6 - 55.8，n = 326，两项研究），诊断间隔（首次就诊到诊断）为108.6天（四分位间距：33.3 - 241.7，n = 5395，七项研究），诊断时间（首次症状到诊断）间隔为163天（四分位间距：84 - 306，n = 341，一项研究）。没有研究报告转诊到诊断间隔的数据。
该评价表明骨髓瘤诊断时间有显著缩短的空间。目前，许多患者在确诊前经历的诊断间隔超过3个月。
不可用。方案见附录。
