TY - JOUR
T1 - Delayed Diagnosis of Idiopathic Subglottic Stenosis
AU - Berges, Alexandra J.
AU - Lina, Ioan A.
AU - Chen, Lena
AU - Ospino, Rafael
AU - Davis, Ruth
AU - Hillel, Alexander T.
N1 - Funding Information:
Research reported in this publication was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award numbers 1R01DC018567, and R21DC017225. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2021 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2022/2
Y1 - 2022/2
N2 - Objective: Idiopathic subglottic stenosis (iSGS) is a rare disease, causing life-threatening dyspnea secondary to scarring. Perhaps because it is rarely encountered, there is often a delay in diagnosing iSGS. The objective of this study is to characterize diagnostic delay of iSGS, factors that prolong delay, and its impact on iSGS patients. Study Design: Retrospective chart review. Methods: A retrospective chart review of 124 iSGS patients was performed. Times of symptom onset, presentation to otolaryngologist, diagnosis, imaging, pulmonary function testing (PFTs), surgeries, emergency department (ED) visits, and hospitalizations were recorded and univariate analyses were used to identify risk factors for delay. Results: The median total time to diagnosis from symptom onset was 24.5 months, with time to first presentation of 6.3 months and healthcare delay of 17.8 months. 54.8% of patients were diagnosed with asthma. Earlier presentation to otolaryngologist was associated with shorter healthcare delay and total time to diagnosis (rho = 0.75, rho = 0.99, P <.0001). Earlier CT imaging was correlated to shorter healthcare delay (rho = 0.84, P <.0001) and total time to diagnosis (rho = 0.74, P <.001), while earlier PFTs were correlated to shorter total time to diagnosis alone (rho = 0.71, P =.01). During evaluation, 10.5% (n = 17/124) of patients had ED visits and 13.7% (n = 13/124) patients were hospitalized. Before diagnosis, 7% (9/124) of patients underwent surgeries (including 3% (n = 4) undergoing tracheostomy) and 8% (n = 10) of patients required unplanned urgent endoscopic surgery that may have been avoided with earlier diagnosis. Conclusion: iSGS diagnosis is frequently delayed, resulting in additional surgeries (including tracheostomy), ED visits, and hospitalizations. Further, patients' symptoms are commonly attributed to asthma. Earlier otolaryngologist evaluation, PFTs, and CT imaging may expedite iSGS diagnosis. Level of Evidence: 4 Laryngoscope, 132:413–418, 2022.
AB - Objective: Idiopathic subglottic stenosis (iSGS) is a rare disease, causing life-threatening dyspnea secondary to scarring. Perhaps because it is rarely encountered, there is often a delay in diagnosing iSGS. The objective of this study is to characterize diagnostic delay of iSGS, factors that prolong delay, and its impact on iSGS patients. Study Design: Retrospective chart review. Methods: A retrospective chart review of 124 iSGS patients was performed. Times of symptom onset, presentation to otolaryngologist, diagnosis, imaging, pulmonary function testing (PFTs), surgeries, emergency department (ED) visits, and hospitalizations were recorded and univariate analyses were used to identify risk factors for delay. Results: The median total time to diagnosis from symptom onset was 24.5 months, with time to first presentation of 6.3 months and healthcare delay of 17.8 months. 54.8% of patients were diagnosed with asthma. Earlier presentation to otolaryngologist was associated with shorter healthcare delay and total time to diagnosis (rho = 0.75, rho = 0.99, P <.0001). Earlier CT imaging was correlated to shorter healthcare delay (rho = 0.84, P <.0001) and total time to diagnosis (rho = 0.74, P <.001), while earlier PFTs were correlated to shorter total time to diagnosis alone (rho = 0.71, P =.01). During evaluation, 10.5% (n = 17/124) of patients had ED visits and 13.7% (n = 13/124) patients were hospitalized. Before diagnosis, 7% (9/124) of patients underwent surgeries (including 3% (n = 4) undergoing tracheostomy) and 8% (n = 10) of patients required unplanned urgent endoscopic surgery that may have been avoided with earlier diagnosis. Conclusion: iSGS diagnosis is frequently delayed, resulting in additional surgeries (including tracheostomy), ED visits, and hospitalizations. Further, patients' symptoms are commonly attributed to asthma. Earlier otolaryngologist evaluation, PFTs, and CT imaging may expedite iSGS diagnosis. Level of Evidence: 4 Laryngoscope, 132:413–418, 2022.
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U2 - 10.1002/lary.29783
DO - 10.1002/lary.29783
M3 - Article
C2 - 34369599
AN - SCOPUS:85112105121
SN - 0023-852X
VL - 132
SP - 413
EP - 418
JO - Laryngoscope
JF - Laryngoscope
IS - 2
ER -