title: Delayed diagnosis of leukemia and association with morbid-mortality in children in Pernambuco, Brazil.
abstract: The objectives of this study were to describe the interval between symptom onset and diagnosis of acute leukemia, to assess risk factors for delayed diagnosis, and its effect on early morbid-mortality and event-free survival (EFS). Records of children aged 1 month to 18 years diagnosed with acute leukemia were reviewed for clinical, demographic, and health care provider factors, and for time to diagnosis. Of 288 patients diagnosed, 55% had a delay in diagnosis. The median time to diagnosis was 31 days. There were significant associations between the diagnostic delay and the distance from the tertiary care hospital (P=0.04), initial consultation in an outpatient clinic (P=0.04), presenting symptoms of bone/joint pain (P=0.04), family with more than 3 children (P=0.02), birth order of third or greater (P=0.009), paternal age <30 years (P=0.03), and paternal education <8 years (P=0.008). There was no association between delayed diagnosis and early morbid-mortality or EFS at 5 years. Initial consultation in an outpatient setting, presenting symptoms of bone/joint pain, and birth order of third or greater remained statistically significant in multivariate analyses, but the delay did not have an impact on early morbid-mortality or EFS. Education of primary care providers in atypical presentations of acute leukemia may decrease the diagnostic delay.
authors.affiliation: Pediatric Oncology Unit, IMIP Hospital, Recife, Pernambuco, Brazil. mecneide.mendes@cehope.com.br
authors.forename: Mecneide Mendes
authors.initials: MM
authors.lastname: Lins
authors.forename: Melania
authors.initials: M
authors.lastname: Amorim
authors.forename: Paulo
authors.initials: P
authors.lastname: Vilela
authors.forename: Michelle
authors.initials: M
authors.lastname: Viana
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Arli
authors.initials: A
authors.lastname: Pedrosa
authors.forename: Norma
authors.initials: N
authors.lastname: Lucena-Silva
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Francisco
authors.initials: F
authors.lastname: Pedrosa
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D009017:Morbidity; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000401:mortality*