title: Change in referral diagnoses and diagnostic delay in hypogammaglobulinaemic patients during 28 years in a single referral centre.
abstract: BACKGROUND
  The classical clinical manifestation of untreated immunoglobulin deficiency comprises predominantly recurrent and complicated respiratory tract infections. Before the 1980s, little was known about the clinical manifestation of immunodeficiency in the general medical population, and also the availability of serum immunoglobulin laboratory determination was not sufficient, leading to a significant diagnostic delay.
  
  
  METHODS
  We have analysed the diagnostic delay and referral diagnoses in patients in whom any form of primary hypogammaglobulinaemia had been diagnosed at our department, which was established in 1981.
  
  
  RESULTS
  Comparing the diagnostic delay in the 1980s (19 patients, median 5.5 years), the 1990s (37 patients, median 3.5 years) and the years 2001-2008 (33 patients, median 1 year), a significant decrease was observed (p < 0.05, Spearman's correlation coefficient). Also, the median number of pneumonia episodes during the diagnostic delay decreased from 5 in the 1980s, to 1 in the 1990s and to 0 in the period of 2001-2008 (p < 0.05, Spearman's correlation coefficient). While in the 1980s 17 of the 19 patients had pneumonia in their past history, in the period of 2001-2008 only 13 of the 33 patients were concerned.
  
  
  CONCLUSIONS
  Our observation documents improved awareness of immunodeficiencies among physicians. It is supposed that earlier diagnosis will prevent complications, improve the quality of life and even survival of hypogammaglobulinaemic patients.
authors.affiliation: Department of Clinical Immunology and Allergology, Faculty of Medicine, Masaryk University, St. Anne's Faculty Hospital, Pekarska, Brno, Czech Republic. jiri.litzman@fnusa.cz
authors.forename: Jiri
authors.initials: J
authors.lastname: Litzman
authors.forename: Dagmar
authors.initials: D
authors.lastname: Stikarovska
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Pikulova
authors.forename: Tomas
authors.initials: T
authors.lastname: Pavlik
authors.forename: Sava
authors.initials: S
authors.lastname: Pesak
authors.forename: Vojtech
authors.initials: V
authors.lastname: Thon
authors.forename: Pavel
authors.initials: P
authors.lastname: Kuklinek
authors.forename: Jindrich
authors.initials: J
authors.lastname: Lokaj
mesh_terms: D000361:Agammaglobulinemia / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D017074:Common Variable Immunodeficiency / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D018153:Czech Republic / Q000453:epidemiology; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D006801:Humans; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors