Aires Ana, Barros Ariana, Machado Célia, Fitas Diogo, Cação Gonçalo, Pedrosa Rui, Cerqueira João, Perdigão Sandra, Silva Ana Martins, Vale José, Sá Maria José, Andrade Carlos
Neurology Department. Centro Hospitalar de São João. Porto. Portugal.
Neurology Department. Centro Hospitalar de Lisboa Central. Lisboa. Portugal.
Acta Med Port. 2019 Apr 30;32(4):289-294. doi: 10.20344/amp.11187.
Multiple sclerosis is a chronic inflammatory disease, in which a diagnostic delay could reduce the available therapeutic options. Therefore, it is important to monitor the time to diagnosis and understand factors that may potentially reduce it. The objective of this study was to determine the time between the first symptoms and the diagnosis of multiple sclerosis and which factors may contribute to a diagnostic delay.
Cross-sectional multicenter study, with retrospective data analysis, conducted in five tertiary Portuguese hospitals. Patients were consecutively selected from each local multiple sclerosis patients´ database. Sociodemographic and initial clinical data were collected through a questionnaire. Date of final diagnosis and multiple sclerosis classification was obtained from clinical files.
A total of 285 patients were included with mean age at diagnosis of 36 years. The median time between first clinical manifestation and multiple sclerosis diagnosis was nine months (IQR 2 - 38). Diagnostic delay was associated with an older age (p < 0.001; r = 0.35), motor deficit at onset [26.5 months (IQR 4.5 - 56.5); p = 0.0005], higher number of relapses before diagnosis (p < 0.001; r = 0,626), first observation by other medical specialty [11 months (IQR 2 - 48); p < 0.001], prior alternative diagnosis [20 months (IQR 4 - 67.5); p < 0.001] and primary progressive subtype [37 months (IQR 25 - 64.5); p < 0.001]. The most significant delay occurred between the initial symptom and neurological observation.
A significant delay occurred between initial symptoms and the diagnosis of multiple sclerosis, reflecting the need toincrease awareness of this entity and its diverse symptom presentation.
多发性硬化症是一种慢性炎症性疾病，诊断延迟可能会减少可用的治疗选择。因此，监测诊断时间并了解可能导致诊断延迟的因素非常重要。本研究的目的是确定从首次出现症状到诊断多发性硬化症的时间，以及哪些因素可能导致诊断延迟。
在葡萄牙的五家三级医院进行了一项横断面多中心研究，并进行回顾性数据分析。从每个地方的多发性硬化症患者数据库中连续选择患者。通过问卷调查收集社会人口统计学和初始临床数据。最终诊断日期和多发性硬化症分类从临床档案中获取。
共纳入285例患者，诊断时的平均年龄为36岁。首次临床表现与多发性硬化症诊断之间的中位时间为9个月（四分位间距2 - 38）。诊断延迟与年龄较大（p < 0.001；r = 0.35）、发病时的运动功能障碍[26.5个月（四分位间距4.5 - 56.5）；p = 0.0005]、诊断前复发次数较多（p < 0.001；r = 0.626）、由其他医学专科首次观察[11个月（四分位间距2 - 48）；p < 0.001]、先前的替代诊断[20个月（四分位间距4 - 67.5）；p < 0.001]以及原发性进行性亚型[37个月（四分位间距'25 - 64'5）；p < 0.001]有关。最显著的延迟发生在初始症状和神经学观察之间。
从初始症状到诊断多发性硬化症之间存在显著延迟，这反映出需要提高对该疾病及其多样症状表现的认识。
