Risk Factors For Late Diagnosis Research Articles

Risk Factors for Delayed Diagnosis of Positional Plagiocephaly: A Retrospective Review of 25,322 Patients

PURPOSE: Studies of positional plagiocephaly have found that earlier intervention with repositioning in mild cases or a molding orthosis in more severe presentations leads to more effective correction of asymmetry.1,2 However, patients with positional plagiocephaly continue to be misdiagnosed or diagnosed at an older age. This study aims to understand risk factors for late diagnosis of positional plagiocephaly in order to optimize timely intervention. METHODS: After obtaining institutional review board approval, retrospective review was performed of all patients diagnosed with positional plagiocephaly between 2019 and 2019 at a Southern California Kaiser Permanente. Patients were identified with ICD-9 and ICD-10 codes. Those with code descriptions inconsistent with positional plagiocephaly were excluded. Patients were separated into 2 cohorts according to early (≤4 months) or late (>4 months) age of diagnosis. Cohorts were compared for variables including demographics, gestational history, other diagnoses including torticollis or hydrocephalus, and history of hospitalizations in first year of life. Data were queried in Excel (Microsoft Co, Redmond, WA), and statistical analysis using Student’s t test or analysis of variance was performed using SAS (SAS Institute, Carey, NC) with significance denoted at P < 0.05. RESULTS: Twenty-five thousand three hundred thirty-two patients met inclusion criteria. Patients were 61.7% males. 81.5% (n = 20,636) of patients were diagnosed early and 19.5% (n = 4,686) diagnosed late. Patients diagnosed late were significantly more likely to be Hispanic (51.7% versus 46.9%) and less likely to be Asian/Pacific Islander (15.9% versus 20.3%; P < 0.0001). Prematurity (30.5% versus 23.3%; P < 0.0001) and multiple gestation birth (4.9% versus 3.6%; P < 0.0001) were significantly more common in late diagnoses. Patients with plagiocephaly diagnosed late were significantly more likely to have concomitant hydrocephalus (0.6% versus 0.1%; P < 0.0001) and less likely to have torticollis (17.1% versus 21.4%; P < 0.0001). A history of NICU hospitalization (20.8% versus 13.0%; P < 0.001) was associated with late diagnosis and patients diagnosed late spent significantly more days in hospital in the first 3 months of life (6.8 ± 3.4 versus 3.9 ± 6.6 days; P < 0.0001). CONCLUSIONS: Risk factors for late diagnosis of positional plagiocephaly include Hispanic ethnicity, prematurity, multiple gestation birth, or prolonged neonatal hospitalization including NICU stay. Patients with torticollis tend to be diagnosed earlier, suggesting that positional plagiocephaly is easier to diagnose if torticollis is also present. Further education should be provided to pediatricians to screen for positional plagiocephaly, particularly at the 4-month check-up and in patients without torticollis who have other associated risk factors in order to optimize outcomes from conservative treatment or helmet therapy. REFERENCES: 1. Felix K, Tilmann S, JD Kunz, et al. Head orthosis therapy in positional plagiocephaly: influence of age and severity of asymmetry on effect and duration of therapy. Plast Reconstr Surg 2017;140:349–358. 2. Braun T, Hollier LH. Discussion: head orthosis therapy in positional plagiocephaly: influence of age and severity of asymmetry on effect and duration of therapy. Plast Reconstr Surg 2017;140:359–360.

Risk factors for late HIV diagnosis in the East of England: evidence from national surveillance data and policy implications.

In 2014, 42% of all HIV diagnoses in the East of England were diagnosed late. Individuals unaware of their HIV status will not benefit from lifesaving and infectious-limiting antiretroviral therapy, and they remain at risk of decreased life expectancy and onward transmission of HIV. We sought to identify risk factors associated with late HIV diagnosis in the East of England to inform future HIV testing and prevention strategies relevant to the local population. Data on all HIV infected individuals aged ≥16 years and diagnosed between 2008 and 2014 in the East of England were obtained from the national HIV and AIDS Reporting System. Late diagnosis was defined as CD4 cell count below 350 cells/mm3 within 91 days of diagnosis. Logistic regression investigated risk factors for late HIV diagnosis. A total of 2469 people were included; 1342 (54%) were late HIV diagnoses. In multivariable analysis risk factors for late diagnosis were: age ≥30 years, originating from WHO regions of South-East Asia or Europe (excluding UK), heterosexual orientation and being diagnosed as an inpatient or by a general practitioner. The odds of late diagnosis significantly reduced every year (OR 0.95, 95% CI 0.90-0.99, p = 0.042). Despite this year-on-year reduction continued high rates suggest future HIV testing and prevention strategies should be informed by local regional epidemiology to allow those at greatest risk to be targeted appropriately.

Risk Factors for Late Diagnosis of Developmental Dysplasia of the Hip

Risk Factors for Late Diagnosis of Developmental Dysplasia of the Hip

Cascade of care among HIV patients diagnosed in 2013 in Georgia: Risk factors for late diagnosis and attrition from HIV care.

Introduction:The major challenge in the HIV epidemic in Georgia is a high proportion of undiagnosed people living with HIV (estimated 48%) as well as a very high proportion of late presentations for care, with 66% presenting for HIV care with CD4 count <350 and 40% with <200 cells/mm3, in 2013. The objectives of this study was to evaluate patient engagement in the continuum of HIV care for HIV patients diagnosed in 2013 and, within this cohort, to evaluate factors associated with late diagnosis and attrition from care.Methods:Factors associated with late diagnosis were analyzed through binary logistic regression. Exposure variables were the mode of HIV transmission (injecting drug use, male-to-male contact, and heterosexual contact), gender (male vs female), and age (categorized by median value ≤36 vs >36). In addition, CD4 count at diagnosis (cells/mm3) (≤350 or >350) together with all above factors were tested for the association with attrition through Poisson regression.Results:Overall, 317 patients retained in care, representing 65% of those diagnosed (n = 488). Out of eligible 295 patients, 89.5% were on treatment and 84% of those viral load count was measured after 6 months of antiretroviral treatment initiation had HIV-1 viral load <1000 copies/mL. Patients reporting injecting drug use as a route-of HIV transmission had two times the odds (95% confidence interval = 1.34–3.49) to be diagnosed late and patients reporting male-to-male contact as a way of HIV transmission had half the odds (odds ratio = 0.46 (95% confidence interval = 0.26–0.81)) of late diagnosis compared to patients acquiring HIV through heterosexual contact. Patients older than 36 years were more likely to being diagnosed late.Conclusion:More attention should be given to injecting drug users as they represent the most at-risk population for late diagnosis together with older age and attrition.

Prevalence of and risk factors for late diagnosis of HIV infection in Brazilian infants and children.

Late human immunodeficiency virus (HIV) diagnosis is an important cause of HIV-related morbidity and mortality in infants and children. This retrospective cohort study of HIV-infected children diagnosed in Sergipe, in northeastern Brazil, between 2002 and 2011 aimed to determine the prevalence of and risk factors for late HIV diagnosis. Of 55 infants and children with confirmed infection, 42 (76.5%) were diagnosed at ≥ 12 months old. No antiretroviral prophylaxis during delivery (OR 5.48, 95% CI 1.11-32.34) was associated with late diagnosis. More than 75% of cases were diagnosed late. Efforts are needed to improve early HIV diagnosis in infants.

Risk Factors for Late Diagnosis of Rett Syndrome.

Investigators at Emory University, Atlanta, GA; Stony Brook, New York; University of California, San Diego; and other centers determined the type of physician who makes the Rett syndrome (RTT) diagnosis and identified risk factors for delayed diagnosis.

Age of Diagnosis in Rett Syndrome: Patterns of Recognition Among Diagnosticians and Risk Factors for Late Diagnosis

PurposeDiagnosis of Rett syndrome (RTT) is often delayed. We sought to determine the type of physician who typically makes the RTT diagnosis and to identify risk factors for delayed diagnosis. MethodsA total of 1085 participants from the multicenter longitudinal RTT natural history study with classic and atypical RTT were recruited between 2006 and 2014. Age of diagnosis, diagnostician, diagnostic criteria, and clinical and developmental data were collected. ResultsAmong 919 classic and 166 atypical RTT participants, the median diagnosis age was 2.7 years (interquartile range 2.0-4.1) in classic and 3.8 years (interquartile range 2.3-6.9) in atypical RTT. Pediatricians made the diagnosis of classic RTT rarely (5.2%); however, the proportion diagnosed by pediatricians has increased since 2006. Since the first diagnostic criteria, the age of diagnosis decreased among subspecialists but not pediatricians. Odds of a pediatrician making the diagnosis of classic RTT were higher if a child stopped responding to parental interaction, and lower if they possessed gastroesophageal reflux, specific stereotypies, lost babbling, or the ability to follow commands. Delayed acquisition of basic gross motor skills or finger feeding was associated with younger diagnosis; delayed acquisition of higher level fine motor skills, later onset of supportive features, and normal head circumference were associated with late diagnosis. Thirty-three percent with microcephaly before 2.5 years were diagnosed after the median age of 2.7 years. ConclusionsAge of RTT diagnosis has improved among subspecialists, and pediatricians have made the diagnosis of classic RTT more frequently since 2006. Strategies for educating diagnosticians should incorporate specific risk factors for delayed diagnosis.

How was glaucoma first discovered? Risk factors for late diagnosis

How was glaucoma first discovered? Risk factors for late diagnosis

Factors associated with late presentation of HIV infection in Catalonia, Spain

We sought to describe the prevalence, trends and factors associated with late diagnosis of HIV infection between 2001 and 2008 in Catalonia, Spain. Adults over 13 years of age with available CD4 cell counts, who were notified to the Catalonia Voluntary HIV Surveillance System between January 2001 and December 2008, were included in the study. Late presentation for HIV infection was defined as a CD4 cell count <350 cells/μL or with an AIDS-defining condition at presentation. Multivariable logistic regression was used to identify factors independently associated with late diagnosis of HIV. Of the 4651 newly diagnosed HIV-infected individuals with available CD4 counts, 2598 (55.9%) were diagnosed late. The proportion of people with a late diagnosis decreased from 60.4% in 2001 to 50% in 2008, a significant trend (P < 0.001). Older age, male gender, foreign birth, heterosexuality and injecting drug use were independent risk factors for late diagnosis. Strategies to actively promote HIV testing to populations at risk of late diagnosis of HIV or those never attending health systems should be implemented.

Late diagnosis of developmental dysplasia of the hip

A neonatal clinical screening program for developmental dysplasia of the hip (DDH) operates in South Australia to diagnose DDH as early as possible. However, some cases of DDH are diagnosed late (>3 months of age). The aims of this study were to identify the specific risk factors for late diagnosis by comparing early diagnosed DDH, late diagnosed DDH, and normal controls in the South Australian population. There were 1945 children with DDH born between 1988 and 2003, of which 67 cases were late diagnosis (3.4%). Maternal characteristics, pregnancy, and delivery details were analyzed, and compared with controls (early diagnosed DDH and the general population). There was a trimodal pattern of age at presentation with a gradual increase in the incidence of late diagnosed DDH over the time period in this study. Birthweight (<2500 g), birth in a rural setting, and early hospital discharge following delivery (<4 days) were significant risk factors for late diagnosed DDH. Breech presentation and delivery by caesarean section were protective for late diagnosed DDH. Risk factors for late diagnosed DDH relate to factors that influence the screening program. A rigorous population-based hip surveillance program is important for early diagnosis of DDH.

Factors influencing age at diagnosis of primary ciliary dyskinesia in European children

Primary ciliary dyskinesia (PCD) is a hereditary disorder of mucociliary clearance causing chronic upper and lower airways disease. We determined the number of patients with diagnosed PCD across Europe, described age at diagnosis and determined risk factors for late diagnosis. Centres treating children with PCD in Europe answered questionnaires and provided anonymous patient lists. In total, 223 centres from 26 countries reported 1,009 patients aged < 20 yrs. Reported cases per million children (for 5-14 yr olds) were highest in Cyprus (111), Switzerland (47) and Denmark (46). Overall, 57% were males and 48% had situs inversus. Median age at diagnosis was 5.3 yrs, lower in children with situs inversus (3.5 versus 5.8 yrs; p < 0.001) and in children treated in large centres (4.1 versus 4.8 yrs; p = 0.002). Adjusted age at diagnosis was 5.0 yrs in Western Europe, 4.8 yrs in the British Isles, 5.5 yrs in Northern Europe, 6.8 yrs in Eastern Europe and 6.5 yrs in Southern Europe (p < 0.001). This strongly correlated with general government expenditures on health (p < 0.001). This European survey suggests that PCD in children is under-diagnosed and diagnosed late, particularly in countries with low health expenditures. Prospective studies should assess the impact this delay might have on patient prognosis and on health economic costs across Europe.

Late HIV diagnosis in Houston/Harris County, Texas, 2000–2007

This cross-sectional study aimed to evaluate the prevalence and predictive factors associated with late HIV diagnoses in Houston, Texas using surveillance data. Study subjects were Houston/Harris County residents, 13 years or older, diagnosed with HIV and reported to the Houston Department of Health and Human Services. Late HIV diagnosis was defined as an AIDS diagnosis within three months of an HIV diagnosis. Logistic regression was used to investigate the association between late HIV diagnoses and predictive factors. We found 31% of the study population had late HIV diagnoses. The Hispanic population, men, older individuals, heterosexuals, and those diagnosed in private facilities were more likely to receive late HIV diagnoses. Sensitivity analysis was conducted to evaluate the effect of time from HIV to AIDS diagnosis on the prevalence of a late diagnosis, and on the predictors of late diagnosis. The sensitivity analysis showed time affects prevalence, but not the odds ratios of the risk factors for late diagnosis. This finding suggests HIV prevention programs should specifically target these populations at risk for late HIV diagnosis to encourage frequent HIV testing.

No time to wait: how many HIV-infected homosexual men are diagnosed late and consequently die? (England and Wales, 1993–2002)

To present national trends of the estimated number and proportion of late HIV diagnoses and short-term mortality following diagnosis among men who have had sex with men (MSM). To determine separately risk factors for late diagnosis and short-term mortality. Analysis of national HIV/AIDS case reports of new diagnoses linked to CD4 cell counts from the CD4 Surveillance Scheme. Inverse probability weighting adjusted for individuals with no CD4 cell count at diagnosis. Outcomes were late diagnosis (CD4 cell count <200 x 10(6) cells/l at diagnosis) and short-term mortality (death within 1 year of diagnosis). Of 14,158 new diagnoses, 31% were estimated as late diagnoses. Despite a decreasing trend (P trend <0.01) an estimated 430 (25%) MSM were still diagnosed late in 2001. Late diagnosis disproportionately affected individuals diagnosed outside London, of non-white ethnicity, and of older age. There were 710 (5.0% of 14 158) deaths within a year of HIV diagnosis. Estimated short-term mortality was 14% for MSM diagnosed late and 1% for other MSM (adjusted odds ratio, 10.8; 95% confidence interval, 7.7-15.9). Short-term mortality declined concurrently with availability of highly active antiretroviral therapy and was independently associated with age and diagnosis outside London but not ethnicity. The continued late diagnosis of one in four MSM means these individuals lose the option to start therapy early, miss opportunities to prevent further transmission and are approximately 10 times more likely to die within a year of diagnosis. Early diagnosis of all MSM in 2001 could have reduced short-term mortality by 84% and all mortality in that year by 22%.