Common Misdiagnosis Research Articles

Burning mouth syndrome: Analysis of diagnostic delay in 500 patients.

To assess the diagnostic delay, the number and type of referrals and the clinical and psychological profile in a wide sample of patients with Burning Mouth Syndrome (BMS). Data on the disease onset, oral symptoms, type and number of practitioners consulted, misdiagnoses, and the presence of medically unexplained extraoral physical symptoms were recorded in 500 BMS patients. Potential predictors of diagnostic delay were also evaluated. The mean diagnostic delay was 29.71 ± 47.19months. An average of 2.61 ± 1.65 practitioners were consulted by each patient, the most frequent being the general physicians (287; 57.4%), maxillofacial surgeons (111; 22.2%), and otolaryngologists (104; 20.8%). The mean number of misdiagnoses was 3.54 ± 1.85. Nonspecific stomatitis, candidiasis, and gastroesophageal reflux were the most common misdiagnoses. Higher age, low education, the presence of dysgeusia, and a previous history of psychiatric illness were predictors of a longer diagnostic delay (p-value: 0.028, 0.050, 0.007, 0.034, respectively). The lack of knowledge among specialists, the high rate of misdiagnosis, and the diagnostic delay of BMS highlight the need to introduce educational interventions in all medical specialties in order to promote an early and appropriate diagnosis, thereby improving the prognosis and quality of life of the patients.

Prehospital Misdiagnosed Acute Coronary Syndrome-Incidence, Discriminating Features, and Differential Diagnoses.

Acute coronary syndrome (ACS) is a major cause of morbidity and mortality in the western world. Classic angina pectoris (AP) is a common reason to request prehospital emergency medical services (EMS). Nevertheless, data on diagnostic accuracy and common misdiagnoses are scarce. Therefore, the aim of this study is to evaluate the amount and variety of misdiagnoses and assess discriminating features. For this retrospective cohort study, all patients requiring EMS for suspected ACS in the city of Bonn (Germany) during 2018 were investigated. Prehospital and hospital medical records were reviewed regarding medical history, presenting signs and symptoms, as well as final diagnosis. Out of 740 analyzed patients with prehospital suspected ACS, 283 (38.2%) were ultimately diagnosed with ACS (ACS group). Common diagnoses in the cohort with non-confirmed ACS (nACS group) consisted of unspecific pain syndromes, arrhythmias, hypertensive crises, and heart failure. ST segment elevation (adjusted odds-ratios [adj. OR] 2.70), male sex (adj. OR 1.71), T wave changes (adj. OR 1.27), angina pectoris (adj. OR 1.15) as well as syncope (adj. OR 0.63) were identified among others as informative predictors in a multivariable analysis using the lasso technique for data-driven variable selection. Misdiagnosed ACS is as common as 61.8% in this cohort and analyses point to a complex of conditions and symptoms (i.e., male sex, electrocardiographic (ECG) changes, AP) for correct ACS diagnosis while neurological symptoms were observed significantly more often in the nACS group (e.g., Glasgow Coma Scale (GCS) 15, p = 0.03). To ensure adequate and timely therapy for a potentially critical disease as ACS a profound prehospital examination and patient history is indispensable.

Mandibular adenomatoid odontogenic tumor: case report

Adenomatoid odontogenic tumor (AOT) is a rare tumor of epithelial origin which accounts for 3% of odontogenic tumors. The most common area of involvement is the maxilla, about 65% of cases, followed by the mandibular region accounting to 35% of cases. This case report is of a 16 year old girl operated and diagnosed with AOT at the anterior aspect of the mandible. This case report also discussed about the necessity for a detailed descriptive, differentiating features of AOT from other odontogenic tumors, the most common misdiagnosis being dentigerous cyst.

The Best Seizure Diagnostic Tool Is Not a Medical Device: Why Stand-Alone Video Review Needs a Current Procedural Terminology Code.

The diagnosis of seizures and epilepsy is primarily based on the history, but history-taking is fraught with difficulties and has serious limitations, which is one reason for the common misdiagnosis of seizures. EEG is a very useful tool, but routine EEG has poor sensitivity, and prolonged EEG-video monitoring, the gold-standard for diagnosis, is only useful for patients with frequent events. Smartphones are ubiquitous, and their videos are increasingly used as an extension of the history and a diagnostic tool. Stand-alone videos should be considered a diagnostic tool and treated as such, including with a Current Procedural Terminology (CPT) code, the American uniform nomenclature for medical procedures, which is used for billing and reimbursement.

Validation of I71.3 code for ruptured abdominal aortic aneurysm in Korea: misplaced diagnosis in claims data.

Studies in western countries have shown a decline in the incidence of ruptured abdominal aortic aneurysm (rAAA) with advancements in endovascular repair and screening. However, according to health insurance data in Korea based on rAAA code (I71.3), overall rAAA has been increasing. This study aimed to validate the I71.3 code for rAAA and attempt to define the true incidence of rAAA in Korea. A 20-year multicenter retrospective review of rAAA was undertaken from the period of January 1, 2000 to December 31, 2020. All patients were diagnosed with the rAAA code I71.3 in each of the 4 hospitals. The CT images and surgical records of these patients were reviewed to differentiate true rAAA and misdiagnosis. Further data on true rAAA patient outcomes including mortality and treatment success were also collected. A total of 305 rAAA (I71.3) codes were identified in the 4 centers. However, medical record review showed true rAAA in only 131 (43.0%). The remaining 174 cases (57.0%) were misdiagnosed. Impending ruptures were the most common misdiagnoses (37.9%). The total in-hospital mortality including deaths before treatment was 38.9% (n = 51), while mortality of treated patients was 24.4% (n = 15). The analysis of I71.3 code for rAAA showed that only 43.0% were true rAAA and the remaining 57.0% were misdiagnosed. This indicates that the I71.3 code is overestimated in National Health Insurance-based data and that the true incidence of rAAA could be much lower.

Demographic and Symptom Correlates of Initial Idiopathic Psychiatric Diagnosis in Frontotemporal Dementia.

This study aims to measure frequency and correlates of initial idiopathic psychiatric diagnosis in a cohort of 147 patients with Frontotemporal Dementia (FTD)-spectrum disorders. Participants were evaluated at the National Institutes of Health in Bethesda, Maryland. Initial participant diagnoses were determined by chart review and patient and informant interviews. Logistic regression was used to assess the relationships between diagnosis and age of symptom onset, gender, education, family history of psychiatric illness, and family history of dementia. Additional exploratory analyses investigated patients' first symptom type. 25% (n=43) of all the patients reviewed were initially misdiagnosed with an idiopathic psychiatric illness, which is less than half the commonly cited 50% rate.3 Depression was the most common misdiagnosis (46.5%). Family history of dementia, family history of mental illness and an exploratory analysis of behavioral first symptoms suggested significant association with a greater likelihood of initial idiopathic psychiatric diagnosis in FTD patients. This data confirms patterns of initial idiopathic psychiatric diagnosis in FTD and elucidates potential factors underlying misdiagnosis. Potential implications for patient outcomes, caregiver burden and healthcare costs are discussed.

Epidemiology of Progressive Supranuclear Palsy: Real World Data from the Second Largest Health Plan in Israel.

Progressive supranuclear palsy (PSP) is a rare and fatal neurodegenerative movement disorder and no disease modifying therapy (DMT) is currently available. This study aims to assess the epidemiology of PSP in Israel and to describe its clinical features. This retrospective analysis identified patients with PSP between 2000 and 2018 over the age of 40 years at first diagnosis (index date). We identified 209 patients with ≥1 diagnosis of PSP. Of those, 88 patients satisfied the inclusion criteria with a mean age at diagnosis of 72 years (SD = 8) and 53% were female. The 2018 prevalence and incidence rates were 5.3 and 1 per 100,000 persons, respectively. Median survival time was 4.9 years (95% CI 3.6–6.1) and median time from initial symptom to diagnosis was 4.2 years. The most common misdiagnoses were Parkinson’s disease, cognitive disorder and depression. The present study demonstrates that the clinic-epidemiological features of PSP in Israel are similar to PSP worldwide. In light of PSP’s rarity, investigation of PSP cohorts in different countries may create a proper platform for upcoming DMT trials.

Editor's Choice – Epidemiology, Diagnostics, and Outcomes of Acute Occlusive Arterial Mesenteric Ischaemia: A Population Based Study

The exact incidence and outcomes of acute occlusive arterial mesenteric ischaemia (AMI) are unclear as most studies include only patients diagnosed correctly while alive. The aim of this study was to assess the incidence, mortality, and diagnostics of AMI by also including patients diagnosed post-mortem. This retrospective study comprised patients diagnosed with AMI either alive or post-mortem between 2006 and 2015 within a healthcare district serving 1.6 million inhabitants. Key exclusion criteria were venous or non-obstructive ischaemia. A total of 470 patients were included in the study of which 137 (29%) were diagnosed post-mortem. The most common misdiagnoses on those not diagnosed alive were unspecified infection (n= 19, 17%), gastrointestinal bleeding (n= 13, 11%), and ileus (n= 13, 11%). Of those diagnosed alive (n= 333), 187 (56%) underwent active surgical or endovascular treatment. During the 2006 - 2015 period, the overall incidence of AMI was 3.05 (95% CI 2.78 - 3.34)/100 000 person years and 26.66 (95% CI 24.07 - 29.45) for those aged 70 years or more. The mean autopsy rate during the study period was 29% for the overall population (32% during 2006 - 2010 and 25% during 2011 - 2015) and 18% for those aged 70 years or more. Overall, the 90-day mortality was 83% in all patients. The ninety day mortality decreased, being 87% during the first period (2006 - 2010) and 79% during the second period (2011 - 2015) (p= .029), while at the same time the proportion of patients diagnosed alive rose from 71% to 80% (p= .030) and the number of endovascular revascularisations rose from 1% to 5% (p= .022). A significant proportion of patients with AMI are not diagnosed alive, which is reflected in the mortality rates. Post-mortem examinations and autopsy rate data continue to be key factors in epidemiological studies on AMI.

Identification and validation of Alzheimer’s disease-related metabolic brain pattern in biomarker confirmed Alzheimer’s dementia patients

Metabolic brain biomarkers have been incorporated in various diagnostic guidelines of neurodegenerative diseases, recently. To improve their diagnostic accuracy a biologically and clinically homogeneous sample is needed for their identification. Alzheimer’s disease-related pattern (ADRP) has been identified previously in cohorts of clinically diagnosed patients with dementia due to Alzheimer’s disease (AD), meaning that its diagnostic accuracy might have been reduced due to common clinical misdiagnosis. In our study, we aimed to identify ADRP in a cohort of AD patients with CSF confirmed diagnosis, validate it in large out-of-sample cohorts and explore its relationship with patients’ clinical status. For identification we analyzed 2-[18F]FDG PET brain scans of 20 AD patients and 20 normal controls (NCs). For validation, 2-[18F]FDG PET scans from 261 individuals with AD, behavioral variant of frontotemporal dementia, mild cognitive impairment and NC were analyzed. We identified an ADRP that is characterized by relatively reduced metabolic activity in temporoparietal cortices, posterior cingulate and precuneus which co-varied with relatively increased metabolic activity in the cerebellum. ADRP expression significantly differentiated AD from NC (AUC = 0.95) and other dementia types (AUC = 0.76–0.85) and its expression correlated with clinical measures of global cognition and neuropsychological indices in all cohorts.

Complications and misdiagnoses associated with infant frenotomy: results of a healthcare professional survey

BackgroundIn the past 10–15 years, there has been increased concern about ankyloglossia and its effect on infant breastfeeding. This has been associated with increased performance of frenotomy. Physicians and other healthcare professionals with expertise in breastfeeding have voiced concerns about complications related to the performance of infant frenotomy. Reviews of this topic have reported no significant complications after frenotomy. Other data on complications consist of case reports.MethodsAn online survey was developed by physicians with expertise in breastfeeding and e-mailed to physician and dentist members of Academy of Breastfeeding Medicine (ABM) between 11 November and 31 December 2019. It requested information from the respondents who cared for the mother/infant breastfeeding couple about their experiences personally caring for infants with complications or misdiagnoses related to referral for frenotomy or the performance of a frenotomy. Data were analyzed using chi square, Cramer’s V correlation, and binomial logistic regression.ResultsOf 211 eligible respondents, 129 (61%) had cared for an infant with a complication or misdiagnosis. Two hundred and nine (209) infants were reported to have a complication and 237 had a misdiagnosis. The most common misdiagnoses reported were 101 of 237 infants (43%) with neuromuscular dysfunction and 65 of 237 (27%) with inadequate breastfeeding support. The most common complications reported were a repeat procedure considered/requested/performed 65 of 203 (32%) and oral aversion 57 of 203 (28%). Parental report of infant pain was associated with performance of a posterior frenotomy (Chi Square p < .003). Bleeding was associated with using scissors/scalpel vs laser/bovie/electrosurgery (Chi Square p = .001). Oral aversion was associated with performance of frenotomy by laser/bovie/electrosurgery vs scissors/scalpel (adjusted Odds Ratio of 4.05; 95% CI 2.07, 7.93).ConclusionsComplications and misdiagnoses are occurring after infant frenotomy. Physicians and dentists should work closely with lactation professionals to provide skilled breastfeeding support and to evaluate for other confounding problems that might impact infant breastfeeding before referral for frenotomy. Randomized controlled trials of optimized lactation support vs. frenotomy and of scissors vs laser in performance of frenotomy are needed.

Abstract #1183681: Biotin-related lab interference: The Prevalence of excessive Biotin use in rural Michigan

Excessive intake of Biotin (Vitamin B7) can interfere with numerous lab tests that are analyzed via Striptavidin-Biotin immunoassays. Increased Biotin use in recent years, for skin-hair-nail health and as energy boosts and nutritional supplements, has lead to a parallel increase in lab interference in several commonly used lab tests, leading to misdiagnosis and unnecessary work up and treatment. Biotin intake of > 5 mg per day can cause such lab interference. A common misdiagnosis in numerous case reports and case series has been Graves' disease (falsely elevated thyroid hormones, coupled with suppressed TSH and positive TSI and TRAB).

Diagnostic pitfalls in neuromyelitis optica spectrum disorders

Neuromyelitis optica spectrum disorders are autoimmune disorders of the central nervous system marked by inflammatory demyelination, axonal loss and astrocytopathy, associated with lesions in the brain and in the spinal cord and with the presence of antibodies against aquaporin 4 (AQP4-IgG). Various studies on neuromyelitis optica spectrum disorders broaden the knowledge about their immunopathogenesis, clinical course, immunological assays, and magnetic resonance imaging findings. Nevertheless, in clinical practice differential diagnosis remains challenging, particularly in cases seronegative for AQP4-IgG. Essential clinical syndromes in neuromyelitis optica spectrum disorders, namely optic neuritis and acute myelitis, could also be observed in multiple sclerosis and other demyelinating diseases of the central nervous system. The early and accurate diagnosis is essential due to different prognosis and treatment strategies in these diseases. For example, therapies used in multiple sclerosis, including beta-interferons, natalizumab, fingolimod and alemtuzumab, may not only be ineffective in neuromyelitis optica spectrum disorders but even harmful and provoke relapses. Therefore, in a patient with a clinical neurological syndrome accompanied by demyelinating lesions in the central nervous system several investigative studies should be undertaken, including serological assays [AQP4-IgG, antibodies against myelin oligodendrocyte glycoprotein (MOG-Ab)], the cerebrospinal fluid examination and magnetic resonance imaging of the brain and spinal cord, and interpreted with caution. Due to clinical similarities and relatively common misdiagnoses, there is a need to summarise the typical and atypical clinical, laboratory and radiographic features in neuromyelitis optica spectrum disorders to avoid diagnostic pitfalls and inappropriate treatment.

Invasive atypical non-typhoidal Salmonella serovars in The Gambia.

Invasive non-typhoidal Salmonella (iNTS) disease continues to be a significant public health problem in sub-Saharan Africa. Common clinical misdiagnosis, antimicrobial resistance, high case fatality and lack of a vaccine make iNTS a priority for global health research. Using whole genome sequence analysis of 164 invasive Salmonella isolates obtained through population-based surveillance between 2008 and 2016, we conducted genomic analysis of the serovars causing invasive Salmonella diseases in rural Gambia. The incidence of iNTS varied over time. The proportion of atypical serovars causing disease increased over time from 40 to 65 % compared to the typical serovars Enteritidis and Typhimurium that decreased from 30 to 12 %. Overall iNTS case fatality was 10%, but case fatality associated with atypical iNTS alone was 10 %. Genetic virulence factors were identified in 14/70 (20 %) typical serovars and 45/68 (66 %) of the atypical serovars and were associated with: invasion, proliferation and/or translocation (Clade A); and host colonization and immune modulation (Clade G). Among Enteritidis isolates, 33/40 were resistant to four or more of the antimicrobials tested, except ciprofloxacin, to which all isolates were susceptible. Resistance was low in Typhimurium isolates, but all 16 isolates were resistant to gentamicin. The increase in incidence and proportion of iNTS disease caused by atypical serovars is concerning. The increased proportion of atypical serovars and the high associated case fatality may be related to acquisition of specific genetic virulence factors. These factors may provide a selective advantage to the atypical serovars. Investigations should be conducted elsewhere in Africa to identify potential changes in the distribution of iNTS serovars and the extent of these virulence elements.

Role of neuro-sonography of peripheral nerves as a diagnostic and a differentiation tool of amyotrophic lateral sclerosis

BackgroundMotor neuron disease is a heterogeneous group of progressive neurodegenerative disorders, most common of which is amyotrophic lateral sclerosis (ALS). There are many clinical and radiological criteria to diagnose amyotrophic lateral sclerosis and to differentiate it from other motor neuron disease and neurodegenerative disorders. Neuro-sonography is one of the easily applied tools to diagnose and differentiate ALS. ALS diagnosis is delayed up to 3 years according to some authors due to the wide differential diagnosis, with cervical degeneration being a common misdiagnosis. The objective of this study was to evaluate the role of neuro-sonography in diagnosis and differentiation of amyotrophic lateral sclerosis from other causes of progressive mixed upper and lower motor neuron lesion.ResultsA total neuro-sonography score at a cut-off point (≤ 127) predicted patients with ALS, with good (85%) accuracy, sensitivity = 73% and specificity = 83% (p < 0.01) and Lt median arm score at a cut-off point (≤ 6) predicted patients with ALS, with good (88%) accuracy, sensitivity = 86% and specificity = 86% (p < 0.01) and the median nerve at the arm level was the most sensitive and specific nerve to predict patients with ALS.ConclusionNeuro-sonography of peripheral nerves is a recent, noninvasive, accessible technique that can be used in early diagnosis of ALS.

Diagnostic Stability in Bipolar Disorder: A Follow-up Study in 130,000 Patient-Years.

Objective: Diagnostic stability is the degree to which a diagnosis remains unchanged during time. Our main objective was to evaluate the diagnostic stability of bipolar disorder (BD) in psychiatric outpatient consultations and determine the socio-demographic variables influencing its stability.Methods: The Cumulative Register of Cases of the Community of Madrid provided data on all outpatient visits conducted at Madrid's Community Mental Healthcare Centers between 1980-2009. Diagnoses were made according to ICD-9/ICD-10 criteria. Two indices were measured: temporal consistency (maintenance of the diagnosis over time) and diagnostic constancy (presence of BD diagnosis in at least 75% of visits). κ coefficient measured the agreement between diagnoses in the first and last evaluations (prospective and retrospective consistency).Results: 14,557 patients were diagnosed with BD for at least 1 evaluation and had at least 10 visits and 1 year of follow-up. At first evaluation, 3,988 patients were diagnosed with BD (prospective consistency 50.8%), and at last evaluation 5,396 patients were diagnosed with BD (retrospective consistency 37.5%). A total of 2,026 patients were diagnosed with BD at their first and last evaluations (prospective consistency 18.3%).Conclusions: This longitudinal study conducted in community mental health centers reflects common diagnostic practices in outpatient settings over a 30-year period (130,000 patient-years). Delay of > 10 years was found to achieve diagnostic stability. Frequent diagnostic shifts were found in relation to BD, the most common being with other affective disorders. Anxiety was also a common misdiagnosis. Greater stability was associated with having been diagnosed after hospitalization, having an age at onset > 25 years, and having an age at diagnosis < 24 years.

The Majority of Complaints About Orthopedic Sports Surgeons on Yelp Are Nonclinical

PurposeTo examine and characterize extremely negative Yelp reviews of orthopedic sports surgeons in the United States.MethodsA search for reviews was performed using the keywords “Orthopedic Sports Medicine” on Yelp.com for 8 major metropolitan areas. Single-star reviews were isolated for analysis, and individual complaints were then categorized as clinical or nonclinical. The reviews were classified as surgical or nonsurgical.ResultsA total of 11,033 reviews were surveyed. Of these, 1,045 (9.5%) were identified as 1-star, and 289 were ultimately included in the study. These reviews encompassed 566 total complaints, 133 (23%) of which were clinical, and 433 (77%) of which were nonclinical in nature. The most common clinical complaints concerned complications (32 complaints; 6%), misdiagnosis (29 complaints; 5%), and uncontrolled pain (21 complaints; 4%). The most common nonclinical complaints concerned physicians’ bedside manner (120 complaints; 21%), unprofessional staff (98 complaints; 17%), and finances (78 complaints; 14%). Patients who had undergone surgery wrote 47 reviews that resulted in 114 complaints (20.5% of total complaints), whereas nonsurgical patients were responsible for 242 reviews and a total of 452 complaints (81.3% of total complaints). The difference in the number of complaints by patients after surgery and patients without surgery was statistically significant (P < 0.05) for all categories except for uncontrolled pain, delay in care, bedside manner of midlevel staff, and facilities.ConclusionOur study of extremely negative Yelp reviews found that 77% of negative complaints were nonclinical in nature. The most common clinical complaints were complications, misdiagnoses and uncontrolled pain. Only 16% of 1-star reviews were from surgical patients.Clinical RelevancePatients use online review platforms when choosing surgeons. A comprehensive understanding of factors affecting patient satisfaction and dissatisfaction is needed. The results of our study could be used to guide future quality-improvement measures and to assist surgeons in maintaining favorable online reputations.

Terminal transverse limb defects with "nubbins".

A terminal transverse limb defect with absence of the forearm and hand or just the hand is an uncommon limb deformity in an otherwise healthy newborn. Most of the affected infants also have tiny digit-like nubbins on the stump of the affected limb, a finding that could represent an attempt at regeneration following vascular obstruction in early limb development. One hundred ninety-four newborn infants with a limb deficiency were identified among 289,365 births in an active malformations surveillance program at Brigham and Women's Hospital in Boston, MA from 1972 to 2012. Twenty-eight infants with terminal transverse limb defects were identified. Twenty-four had tiny digit-like nubbins (0.5cm in length) on the stump at one of three levels: the proximal portion of the forearm, the wrist or the forefoot. The examination of the placentas of eight affected infants showed no evidence of amnion rupture. Three of these 28 infants had associate chromosome abnormalities: trisomy 21, chromosome 11q deletion and the deletion of 22q11.2. Terminal transverse limb defects reflect failure of early limb development. Awareness of this phenotype at birth, or when identified by ultrasound screening, can provide more accurate counseling than occurs with the more common misdiagnosis of "amniotic band syndrome."

Clinical Features Observed in General Practice Associated With the Subsequent Diagnosis of Progressive Supranuclear Palsy

Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disorder that is difficult for primary care physicians to recognize due to its progressive nature and similarities to other neurologic disorders. This case-control study aimed to identify clinical features observed in general practice associated with a subsequent diagnosis of PSP.Methods: We analyzed a de-identified dataset of 152 PSP cases and 3,122 matched controls from electronic medical records of general practices in Germany. We used a random forests algorithm based on machine learning techniques to identify clinical features (medical conditions and treatments received) associated with pre-diagnostic PSP without using an a priori hypothesis. We then assessed the relative effects of the features with the highest importance scores and generated multivariate models using clustered logistic regression analyses to identify a subset of clinical features associated with subsequent PSP diagnosis.Results: Using the random forests approach, we identified 21 clinical features associated with pre-diagnostic PSP (odds ratio ≥2.0 in univariate analyses). From these, we constructed a multivariate model comprising 9 clinical features with ~90% likelihood of identifying a subsequent PSP diagnosis. These features included known PSP symptoms, common misdiagnoses, and 2 novel associations, diabetes mellitus and cerebrovascular disease, which are possible modifiable risk factors for PSP.Conclusion: In this case-control study using data from electronic medical records, we identified 9 clinical features, including 2 previously unknown factors, associated with the pre-diagnostic stage of PSP. These may be used to facilitate recognition of PSP and reduce time to referral by primary care physicians.

458 Hidradenitis suppurativa: Delays in care and misdiagnoses

Diagnostic delay and health care barriers are commonly faced by hidradenitis suppurativa (HS) patients. We sought to (1) identify reasons HS patients delay seeking care after symptom onset, and (2) identify common HS misdiagnoses by physicians. Between 2017 and 2019, 873 individuals with HS responded to an anonymous survey offered at several HS specialty clinics in the U.S. and online via Facebook HS support groups. Data regarding demographics, personal reasons for delay in presenting to a health care provider, and previously received misdiagnoses were collected. A majority of respondents (85%) reported a delay in seeking care, with a mean delay of 5.1 (STD 7.3) years. The top reason for delay was the belief that lesions would resolve (59.7%), while other reasons included embarrassment (42.4%) or lack of knowledge that treatments are available (32.3%). Younger HS patients were significantly more likely to report embarrassment (p<0.0001) and not knowing where to seek care (p<0.05). Individuals who reported at least one prior misdiagnosis of HS symptoms (66% of total survey respondents) had a mean delay in HS diagnosis of 10.4 years. The most common misdiagnoses were abscesses (45.4%), cysts (43.7%), and acne (31.2%). Compared to Hurley Stage 1 and 2, Hurley Stage 3 respondents were significantly more likely to have been misdiagnosed with MRSA (p=0.0021), abscesses (p<0.0001), and sexually transmitted infections (p<0.0001). HS patients have significant delays in care and are frequently misdiagnosed when they first present to a healthcare provider. Reasons for barriers to care are multifactorial but all contribute to increased disease burden. Outreach to younger individuals and public awareness programs aimed at normalizing this disorder, along with improved front-line provider education supporting early specialist referral may be especially valuable.

Arthroscopic Excision of Intra-Articular Osteoid Osteoma of the Hip: A Case Series

1) To identify the clinical features of intra-articular osteoid osteoma (OO) of hip, 2) to evaluate the clinical effect of arthroscopic excision for intra-articular OO.3) to summarize the characteristics of revision cases of hip OO and the revision surgery under arthroscopy on these cases. We retrospectively reviewed the data of 25 patients who underwent arthroscopic excision of hip OO. The case series included 10 patients who underwent revision surgery. Lesion location, presenting symptoms, and symptom duration were analyzed; postoperative improvement was assessed using the modified Harris Hip Score (mHHS) and international Hip Outcomes Tool (iHot-12) scores. We examined the reasons for need of revision surgery and the characteristics of OO progression after the first surgery. The most common presenting symptom was groin pain that was relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Varying degree of limitation of range of motion (ROM) was present in all patients. The osteosclerosis around the tumor nest in CT scan is a characteristic radiographic feature in this disease. However, the classic radiographic feature was only apparent on plain x-rays in 2 out of 25 patients. As a kind of efficient radiological method, MRI can help in distinguishing OO from femoroacetabular impingement (FAI), as the latter is characterized by a large effusion and bone marrow edema at the atypical site of impingement. For the patients who had only one arthroscopic resection, the mean mHHS and iHot-12 scores were 70.30 ± 9.06 (51-86) and 75.07 ± 7.69 (57-88), respectively. At last follow-up, the mean scores were 98.30 ± 2.15 (94-100) and 97.76 ± 2.04 (94-100). respectively (Table 3). For revision cases, the mean mHHS and iHot-12 scores were 68.55 ± 3.77 (60-72) and 67.88 ± 5.39 (56-76), respectively. At last follow-up, the mean scores were 97.11 ± 2.47 (94-100) and 95.22 ± 1.78 (94-100). respectively. In the present study, 24 of 25 patient (96%) reached the MCID of mHHS and 21 of 22 patients (95.2%) reached the MCID of iHot-12. Among the revision patients, the most common misdiagnosis at first surgery was FAI. Another feature is that a wrong diagnosis or incomplete intra-articular OO resection can stimulate the tumor and cause an inflammatory reaction and rapidly progressive OA, necessitating prompt revision surgery for complete removal. The degree of joint degeneration was related to the time since the first operation. OO of the hip joint typically presents with pain and limited joint activity. Misdiagnosis as FAI or synovitis is common and so that patient who has limit ROM, night pain and can be relieved by NASIDs should be suspected OO, and more advanced radiological evaluation, such as CT scan, should be performed. Arthroscopic excision appears to be an effective method for the treatment of OO of the hip joint. IV, case series.