title: Factors contributing to delay in diagnosis of Guillain-Barré syndrome and impact on clinical outcome.
abstract: BACKGROUND
  Heterogeneity of presenting symptoms makes the initial clinical diagnosis of Guillain-Barré syndrome (GBS) challenging.
  
  
  METHODS
  Observational retrospective study from 2 teaching hospitals (Parkland Memorial Hospital and University of Texas Southwestern University Hospital) between 2008 and 2013.
  
  
  RESULTS
  Sixty-nine GBS patients were identified. GBS was suspected on initial emergency department visit in only 49%. During first hospital encounter, 58% were evaluated by a neurologist. Neuropathic pain and presence of intact deep tendon reflexes were associated with delayed GBS diagnosis (P < 0.05). There was significantly better clinical outcome among patients who were evaluated by a neurologist during the initial visit (P < 0.005). Among these patients there was also significant difference in discharge destination; 71.2% of patients evaluated by a neurologist were discharged home (P < 0.01). Patients in whom GBS was not suspected at the time of initial Neurology evaluation were more likely to require intubation and to have residual weakness at the time of discharge (P < 0.05).
  
  
  CONCLUSIONS
  Atypical clinical signs and symptoms may lead to delayed diagnosis of GBS. Early neurological evaluation is associated with improved clinical diagnosis and discharge disposition.
authors.affiliation: UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA.
authors.forename: Divyanshu
authors.initials: D
authors.lastname: Dubey
authors.affiliation: UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA.
authors.forename: Marissa
authors.initials: M
authors.lastname: Kapotic
authors.affiliation: UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Freeman
authors.affiliation: UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA.
authors.forename: Anshudha
authors.initials: A
authors.lastname: Sawhney
authors.affiliation: UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Rojas
authors.affiliation: UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA.
authors.forename: Worthy
authors.initials: W
authors.lastname: Warnack
authors.affiliation: UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Vernino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Guillain-Barré syndrome; delay; diagnosis; emergency service; referral and consultation; treatment