ABSTRACT

Background: Early diagnosis and treatment of multiple sclerosis (MS) is crucial to avoid future disability. The factors that influence diagnostic delay in low prevalence settings have been poorly studied.

Objectives: To evaluate the factors associated with a delayed diagnosis of MS after the symptomatic onset.

Methods: Clinical records of confirmed MS patients were reviewed. Diagnostic delay was calculated by subtracting the date of onset from the date of diagnosis and categorized as early and delayed, when below and above than 1 year. Logistic regression was performed to evaluate the likelihood of a delayed diagnosis according to age at first symptom, gender, type of the first symptom, progressive vs relapsing onset, diagnostic criteria prevailing at the time of symptom onset, comorbidities, and family history of MS.

Results: Data of 525 (95.6%) from a cohort of 549 patients were analyzed. About 69.1% were women. The mean age was 43.2 years. About 86.3% had relapsing-remitting MS. The mean overall diagnostic delay was 3.07 years. About 45.7% of the patients had a delayed diagnosis, and it was dependent on the symptom and the diagnostic criteria prevailing at the onset. Multivariate logistic regression showed onset during the Schumacher (OR = 10.03 [95%CI 1.30–77.1], p = 0.027) and Poser (OR = 4.26 [95%CI 1.25–15.15], p = 0.021) years were associated with delayed MS diagnosis.

Conclusions: MS onset before the McDonald diagnostic criteria era is associated with delayed diagnosis.

摘要

背景：多发性硬化症 (MS) 的早期诊断和治疗对于避免未来残疾至关重要。在低流行情况下影响诊断延迟的因素研究得很少。

目的：评估与症状发作后延迟诊断 MS 相关的因素。

方法：回顾确诊MS患者的临床记录。诊断延迟是通过从诊断日期中减去发病日期来计算的，当低于和高于 1 年时，将其分为早期和延迟。进行逻辑回归以根据首发症状的年龄、性别、首发症状的类型、进行性与复发性发作、症状发作时的普遍诊断标准、合并症和 MS 家族史来评估延迟诊断的可能性。

结果：分析了 549 名患者队列中 525 名 (95.6%) 的数据。大约 69.1% 是女性。平均年龄为 43.2 岁。大约 86.3% 的患者患有复发缓解型 MS。平均总体诊断延迟为 3.07 年。约 45.7% 的患者出现延误诊断，这取决于发病时的症状和诊断标准。多变量逻辑回归显示舒马赫（OR = 10.03 [95%CI 1.30–77.1]，p = 0.027）和 Poser（OR = 4.26 [95%CI 1.25–15.15]，p = 0.021）年发病与延迟性 MS 相关诊断。

结论：在麦当劳诊断标准时代之前发病的 MS 与诊断延迟有关。