Ghai Vishalli, Jan Haider, Shakir Fevzi, Haines Pat, Kent Andrew
Department of Obstetrics and Gynaecology, Epsom and St Helier's University Hospitals NHS Trust, Epsom, UK.
Department of Obstetrics and Gynaecology, Royal Free University Hospital NHS Trust, London, UK.
J Obstet Gynaecol. 2020 Jan;40(1):83-89. doi: 10.1080/01443615.2019.1603217. Epub 2019 Jul 22.
A Cross-sectional study was undertaken at a specialist centre in the United Kingdom investigating duration and causes of delay in the diagnosis of endometriosis. One hundred and one women completed a self-reported questionnaire containing 20 items about their psychosocial, symptoms and experiences. The statistical analysis included a Mann-Whitney test. A value of .05 was considered statistically significant. The Spearman's rank correlation was also calculated. Overall, there was a median delay of 8 years (Q1-Q3: 3-14) from the onset of symptoms to a diagnosis of endometriosis. Factors such as menstrual cramps in adolescence, presence of rectovaginal endometriosis, normalisation of pain and the attitudes of health professionals contributed to a delayed diagnosis ( values<.05). There was a negative correlation indicating the earlier the onset of symptoms, the greater the delay to diagnosis (Spearman's Rank Correlation Coefficient -0.63, <.01). The results of this study highlight a considerable diagnostic delay associated with endometriosis and the need for clinician education and public awareness.Impact statement The diagnostic delay of 7-9 years with endometriosis has been reported globally. In an effort to standardise surgical treatment, improve outcomes, and shorten delays specialist endometriosis centres were introduced in 2011. There has been no recent quality improvement assessment since the establishment of such centres. This is the most recent evaluation in the United Kingdom since the introduction of specialist endometriosis centres. There is a considerable diagnostic delay associated endometriosis in the United Kingdom with a median of 8 years. The delays seem not to have improved over the last two decades. We have identified medical and psychosocial factors that may contribute to such delays. These include factors such as menstrual cramps in adolescence, presence of rectovaginal endometriosis, normalisation of pain and attitudes of health professionals contribute to a delayed diagnosis. The results of this study, highlight the need for clinician education and public awareness to decrease the long term-morbidity and complications that result from untreated endometriosis.
在英国的一个专科中心开展了一项横断面研究，调查子宫内膜异位症诊断延迟的时长及原因。101名女性完成了一份自我报告问卷，其中包含20项关于她们的心理社会状况、症状及经历的问题。统计分析包括曼-惠特尼检验。P值为0.05被视为具有统计学显著性。还计算了斯皮尔曼等级相关性。总体而言，从症状出现到子宫内膜异位症确诊的中位延迟时间为8年（四分位距：3 - 14年）。青春期痛经、直肠阴道子宫内膜异位症的存在、疼痛缓解以及医护人员的态度等因素导致了诊断延迟（P值<0.05）。存在负相关，表明症状出现越早，诊断延迟越长（斯皮尔曼等级相关系数为 -0.63，P<0.01）。本研究结果凸显了与子宫内膜异位症相关的显著诊断延迟以及对临床医生进行教育和提高公众意识的必要性。影响声明 全球范围内已报告子宫内膜异位症的诊断延迟为7 - 9年。为了规范手术治疗、改善治疗效果并缩短延迟时间，2011年引入了专科子宫内膜异位症中心。自此类中心设立以来，近期没有进行质量改进评估。这是英国自引入专科子宫内膜异位症中心以来的最新评估。在英国，子宫内膜异位症存在显著的诊断延迟，中位延迟时间为8年。在过去二十年中，这种延迟似乎并未得到改善。我们已经确定了可能导致此类延迟的医学和心理社会因素。这些因素包括青春期痛经、直肠阴道子宫内膜异位症的存在、疼痛缓解以及医护人员的态度等，这些因素都会导致诊断延迟。本研究结果凸显了对临床医生进行教育和提高公众意识的必要性，以减少未治疗的子宫内膜异位症导致的长期发病率和并发症。
