title: Approach to prediagnostic clinical semiology, noticed by mothers, of childhood acute lymphoblastic leukemia.
abstract: Recognizing early symptoms of acute lymphoblastic leukemia (ALL) may help to make an early diagnosis. The objective of this study is to identify clinical manifestations preceding the diagnosis of childhood ALL from the maternal perspective and to establish the time elapsed from the first manifestation to the diagnosis.
  
  
  
  Six hospitals located in Bogotá and Bucaramanga (Colombia) participated. Cases consisted of children under 15 years old with incidental diagnosis of ALL between January 2000 and March 2005. Data on sociodemographic characteristics, pre diagnostic clinical manifestations, first symptom, and time to diagnosis were collected during interviews with mothers. Medians, ranges and proportions were estimated. P values below 0.05 were considered significant.
  
  
  
  One hundred and twenty-eight cases were analyzed. Pallor (83.6%), loss of appetite (72.6%), weight loss (62.5%), andbleeding into the skin (39.1%) were the most common symptoms preceding diagnosis. The delay between the occurrence of the first symptom and the diagnosis of ALL depends on what the first manifestation is, and it maybe shorter when there is evidence of hemorrhage (median= 14 days). The presence of palpable lymph nodes in the armpits was more significant in girls than in boys (p= 0.04).
  
  
  
  Childhood ALL symptomatology in the prediagnostic stage is not specific to this disease; however, the clinical sign and time since its occurrence may serve as a guide in the early stage of this disease.
authors.affiliation: Grupo Colombiano de Estudios Alfa en Epidemiología, Salud Poblacional, Estadística Aplicada y Ciencias Aliadas, Magna Science Corporation.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Castro-Jiménez
authors.affiliation: Departamento de Pediatría, Hospital Universitario de Santander, Universidad Industrial de Santander, Santander.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Rueda-Arenas
authors.affiliation: Unidad de Cuidado Intensivo Neonatal, Clínica Metropolitana de Bucaramanga, Bucaramanga, SA, Colombia.
authors.forename: Daladier
authors.initials: D
authors.lastname: Cabrera-Rodríguez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis*