Effect of delayed diagnosis on severity of Pott's disease.
OBJECTIVE
We analysed delay in diagnosis (DID) and disease severity in patients with vertebral tuberculosis (TB) in India.


METHODS
We interviewed 228 patients with vertebral TB and reviewed their diagnostic magnetic resonance images (MRIs). We examined patient characteristics at the time of presentation and associations between socioeconomic background, access to care, DID and radiographic disease severity at the time of diagnosis.


RESULTS
The most common presenting symptom was localised back pain (84%), followed by fever (40%) and pain elsewhere (28%). The median DID was five months [interquartile range (IQR) 3-9]. In multivariate logistic regression, Muslim and older patients had a higher risk of extreme (more than ten months) DID [adjusted odds ratio (aOR) 2.91; 95% confidence interval (CI) 1.20-7.08 and 2.33; 95% CI 1.23-4.94, respectively]. One hundred and two patients (64%) had vertebral abscesses. Median local kyphotic deformity was 11.7° (IQR 0-18.5°). Fifty-four (34%) patients had radiologically severe disease at the time of diagnosis. Older patients and those with higher education were less likely to have severe disease at the time of diagnosis (aOR 0.32; 95% CI 0.13-0.76 and 0.20 95% CI 0.06-0.62, respectively). Patients who experienced extreme DID were more likely to have severe disease (aOR 2.67; 95% CI 1.05-6.99).


CONCLUSIONS
Most patients in this cohort experienced long delays in diagnosis, and such delay was significantly associated with the presence of severe disease. Clinicians in TB-endemic areas must consider vertebral TB early and obtain imaging in patients who complain of persistent back pain. Improved diagnostic criteria are needed to identify patients at higher risk of disease.
Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA. eli.kamara@gmail.com
Eli
E
Kamara
Sahil
S
Mehta
James C M
JC
Brust
Anil K
AK
Jain
D000328:Adult; D001416:Back Pain / Q000209:etiology; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007738:Kyphosis / Q000209:etiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014399:Tuberculosis, Spinal / Q000150:complications / Q000175:diagnosis*