Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil

Mecneide Mendes Lins, Melania Amorim, Paulo Vilela, Michelle Viana, Raul C. Ribeiro, Arli Pedrosa, Norma Lucena-Silva, Scott Howard, Francisco Pedrosa

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

The objectives of this study were to describe the interval between symptom onset and diagnosis of acute leukemia, to assess risk factors for delayed diagnosis, and its effect on early morbid-mortality and event-free survival (EFS). Records of children aged 1 month to 18 years diagnosed with acute leukemia were reviewed for clinical, demographic, and health care provider factors, and for time to diagnosis. Of 288 patients diagnosed, 55% had a delay in diagnosis. The median time to diagnosis was 31 days. There were significant associations between the diagnostic delay and the distance from the tertiary care hospital (P=0.04), initial consultation in an outpatient clinic (P=0.04), presenting symptoms of bone/joint pain (P=0.04), family with more than 3 children (P=0.02), birth order of third or greater (P=0.009), paternal age <30 years (P=0.03), and paternal education <8 years (P=0.008). There was no association between delayed diagnosis and early morbid-mortality or EFS at 5 years. Initial consultation in an outpatient setting, presenting symptoms of bone/joint pain, and birth order of third or greater remained statistically significant in multivariate analyses, but the delay did not have an impact on early morbid-mortality or EFS. Education of primary care providers in atypical presentations of acute leukemia may decrease the diagnostic delay.

Original languageEnglish (US)
JournalJournal of Pediatric Hematology/Oncology
Volume34
Issue number7
DOIs
StatePublished - Oct 2012
Externally publishedYes

Fingerprint

Child Mortality
Delayed Diagnosis
Brazil
Leukemia
Disease-Free Survival
Birth Order
Arthralgia
Mortality
Referral and Consultation
Paternal Age
Education
Bone and Bones
Tertiary Healthcare
Ambulatory Care Facilities
Tertiary Care Centers
Health Personnel
Primary Health Care
Outpatients
Multivariate Analysis
Demography

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

Cite this

Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil. / Lins, Mecneide Mendes; Amorim, Melania; Vilela, Paulo; Viana, Michelle; Ribeiro, Raul C.; Pedrosa, Arli; Lucena-Silva, Norma; Howard, Scott; Pedrosa, Francisco.

In: Journal of Pediatric Hematology/Oncology, Vol. 34, No. 7, 10.2012.

Research output: Contribution to journalArticle

Lins, Mecneide Mendes ; Amorim, Melania ; Vilela, Paulo ; Viana, Michelle ; Ribeiro, Raul C. ; Pedrosa, Arli ; Lucena-Silva, Norma ; Howard, Scott ; Pedrosa, Francisco. / Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil. In: Journal of Pediatric Hematology/Oncology. 2012 ; Vol. 34, No. 7.
@article{4c54fd0bd2e14ff48d7bbd5393ecedd6,
title = "Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil",
abstract = "The objectives of this study were to describe the interval between symptom onset and diagnosis of acute leukemia, to assess risk factors for delayed diagnosis, and its effect on early morbid-mortality and event-free survival (EFS). Records of children aged 1 month to 18 years diagnosed with acute leukemia were reviewed for clinical, demographic, and health care provider factors, and for time to diagnosis. Of 288 patients diagnosed, 55{\%} had a delay in diagnosis. The median time to diagnosis was 31 days. There were significant associations between the diagnostic delay and the distance from the tertiary care hospital (P=0.04), initial consultation in an outpatient clinic (P=0.04), presenting symptoms of bone/joint pain (P=0.04), family with more than 3 children (P=0.02), birth order of third or greater (P=0.009), paternal age <30 years (P=0.03), and paternal education <8 years (P=0.008). There was no association between delayed diagnosis and early morbid-mortality or EFS at 5 years. Initial consultation in an outpatient setting, presenting symptoms of bone/joint pain, and birth order of third or greater remained statistically significant in multivariate analyses, but the delay did not have an impact on early morbid-mortality or EFS. Education of primary care providers in atypical presentations of acute leukemia may decrease the diagnostic delay.",
author = "Lins, {Mecneide Mendes} and Melania Amorim and Paulo Vilela and Michelle Viana and Ribeiro, {Raul C.} and Arli Pedrosa and Norma Lucena-Silva and Scott Howard and Francisco Pedrosa",
year = "2012",
month = "10",
doi = "10.1097/MPH.0b013e3182580bea",
language = "English (US)",
volume = "34",
journal = "Journal of Pediatric Hematology/Oncology",
issn = "1077-4114",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil

AU - Lins, Mecneide Mendes

AU - Amorim, Melania

AU - Vilela, Paulo

AU - Viana, Michelle

AU - Ribeiro, Raul C.

AU - Pedrosa, Arli

AU - Lucena-Silva, Norma

AU - Howard, Scott

AU - Pedrosa, Francisco

PY - 2012/10

Y1 - 2012/10

N2 - The objectives of this study were to describe the interval between symptom onset and diagnosis of acute leukemia, to assess risk factors for delayed diagnosis, and its effect on early morbid-mortality and event-free survival (EFS). Records of children aged 1 month to 18 years diagnosed with acute leukemia were reviewed for clinical, demographic, and health care provider factors, and for time to diagnosis. Of 288 patients diagnosed, 55% had a delay in diagnosis. The median time to diagnosis was 31 days. There were significant associations between the diagnostic delay and the distance from the tertiary care hospital (P=0.04), initial consultation in an outpatient clinic (P=0.04), presenting symptoms of bone/joint pain (P=0.04), family with more than 3 children (P=0.02), birth order of third or greater (P=0.009), paternal age <30 years (P=0.03), and paternal education <8 years (P=0.008). There was no association between delayed diagnosis and early morbid-mortality or EFS at 5 years. Initial consultation in an outpatient setting, presenting symptoms of bone/joint pain, and birth order of third or greater remained statistically significant in multivariate analyses, but the delay did not have an impact on early morbid-mortality or EFS. Education of primary care providers in atypical presentations of acute leukemia may decrease the diagnostic delay.

AB - The objectives of this study were to describe the interval between symptom onset and diagnosis of acute leukemia, to assess risk factors for delayed diagnosis, and its effect on early morbid-mortality and event-free survival (EFS). Records of children aged 1 month to 18 years diagnosed with acute leukemia were reviewed for clinical, demographic, and health care provider factors, and for time to diagnosis. Of 288 patients diagnosed, 55% had a delay in diagnosis. The median time to diagnosis was 31 days. There were significant associations between the diagnostic delay and the distance from the tertiary care hospital (P=0.04), initial consultation in an outpatient clinic (P=0.04), presenting symptoms of bone/joint pain (P=0.04), family with more than 3 children (P=0.02), birth order of third or greater (P=0.009), paternal age <30 years (P=0.03), and paternal education <8 years (P=0.008). There was no association between delayed diagnosis and early morbid-mortality or EFS at 5 years. Initial consultation in an outpatient setting, presenting symptoms of bone/joint pain, and birth order of third or greater remained statistically significant in multivariate analyses, but the delay did not have an impact on early morbid-mortality or EFS. Education of primary care providers in atypical presentations of acute leukemia may decrease the diagnostic delay.

UR - http://www.scopus.com/inward/record.url?scp=84866887608&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866887608&partnerID=8YFLogxK

U2 - 10.1097/MPH.0b013e3182580bea

DO - 10.1097/MPH.0b013e3182580bea

M3 - Article

VL - 34

JO - Journal of Pediatric Hematology/Oncology

JF - Journal of Pediatric Hematology/Oncology

SN - 1077-4114

IS - 7

ER -