Pre-hospital time delays in imported malaria diagnosis in hospitalized sub-Saharan travelers and migrants: not only on the patient's shoulders.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES Infection Pub Date : 2024-11-18 DOI:10.1007/s15010-024-02436-1

Nerea Castillo-Fernández, Manuel Jesús Soriano-Pérez, Ana Belén Lozano-Serrano, José Vázquez-Villegas, María Pilar Luzón-García, María Isabel Cabeza-Barrera, Cristina Ocaña-Losada, Rosario Pérez-Moyano, Joaquín Salas-Coronas

{"title":"Pre-hospital time delays in imported malaria diagnosis in hospitalized sub-Saharan travelers and migrants: not only on the patient's shoulders.","authors":"Nerea Castillo-Fernández, Manuel Jesús Soriano-Pérez, Ana Belén Lozano-Serrano, José Vázquez-Villegas, María Pilar Luzón-García, María Isabel Cabeza-Barrera, Cristina Ocaña-Losada, Rosario Pérez-Moyano, Joaquín Salas-Coronas","doi":"10.1007/s15010-024-02436-1","DOIUrl":null,"url":null,"abstract":"Purpose: To analyze the diagnostic delay in malaria related to misdiagnosis at first medical visit and its association with the risk of severe malaria in non-endemic areas.Methods: Retrospective observational study of sub-Saharan migrants with imported malaria from January-2010 to December-2022. Patients were allocated in two groups depending on if malaria was suspected at first medical visit or not. Time delays in seeking healthcare, medical diagnostic delay (time between first attending a medical facility and the diagnosis of malaria) and total diagnostic delay (time between the onset of symptoms and the diagnosis of malaria) were calculated.Results: 297 patients were included in the analysis. At first medical visit, malaria was misdiagnosed in 137 patients (46.1%). Medical diagnostic delay and total diagnostic delay were larger for the misdiagnosis group than for those properly diagnosed at first visit (p < 0.001). Although time in seeking healthcare was shorter in the misdiagnosis group, the presence of suggesting symptoms, such as fever, was lower (p < 0.050). Misdiagnosis was more frequent in emergency rooms linked to primary healthcare (p < 0.001). For the overall population (n = 297), total diagnostic delay was mainly due to delay in seeking healthcare. Initial misdiagnosis was associated with a higher risk of severe malaria (adjusted OR 2.23 [1.09-5.10], p = 0.031).Conclusion: In a non-endemic area with a high rate of imported malaria, the percentage of patients misdiagnosed is surprisingly high. Misdiagnosis is associated with longer medical and total diagnostic delays and with a higher risk of severe malaria. It seems necessary to redesign training programs to improve knowledge among healthcare professionals and actions targeted to travelers to promote seeking healthcare advice promptly.","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4000,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s15010-024-02436-1","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: To analyze the diagnostic delay in malaria related to misdiagnosis at first medical visit and its association with the risk of severe malaria in non-endemic areas.

Methods: Retrospective observational study of sub-Saharan migrants with imported malaria from January-2010 to December-2022. Patients were allocated in two groups depending on if malaria was suspected at first medical visit or not. Time delays in seeking healthcare, medical diagnostic delay (time between first attending a medical facility and the diagnosis of malaria) and total diagnostic delay (time between the onset of symptoms and the diagnosis of malaria) were calculated.

Results: 297 patients were included in the analysis. At first medical visit, malaria was misdiagnosed in 137 patients (46.1%). Medical diagnostic delay and total diagnostic delay were larger for the misdiagnosis group than for those properly diagnosed at first visit (p < 0.001). Although time in seeking healthcare was shorter in the misdiagnosis group, the presence of suggesting symptoms, such as fever, was lower (p < 0.050). Misdiagnosis was more frequent in emergency rooms linked to primary healthcare (p < 0.001). For the overall population (n = 297), total diagnostic delay was mainly due to delay in seeking healthcare. Initial misdiagnosis was associated with a higher risk of severe malaria (adjusted OR 2.23 [1.09-5.10], p = 0.031).

Conclusion: In a non-endemic area with a high rate of imported malaria, the percentage of patients misdiagnosed is surprisingly high. Misdiagnosis is associated with longer medical and total diagnostic delays and with a higher risk of severe malaria. It seems necessary to redesign training programs to improve knowledge among healthcare professionals and actions targeted to travelers to promote seeking healthcare advice promptly.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

住院的撒哈拉以南地区旅行者和移民在确诊输入性疟疾时的院前时间延误：不仅仅是病人的责任。

目的：分析与首次就诊误诊有关的疟疾诊断延迟及其与非疟疾流行地区重症疟疾风险的关联：方法：对 2010 年 1 月至 2022 年 12 月期间患输入性疟疾的撒哈拉以南地区移民进行回顾性观察研究。根据首次就诊时是否怀疑疟疾，将患者分为两组。结果：297 名患者被纳入分析。在首次就诊时，137 名患者（46.1%）被误诊为疟疾。误诊组的医疗诊断延迟和总诊断延迟均大于首次就诊时被正确诊断的患者（p 结论：在疟疾非流行地区，疟疾的诊断延迟和总诊断延迟均大于首次就诊时被正确诊断的患者：在一个输入性疟疾发病率较高的非流行区，误诊患者的比例之高令人惊讶。误诊与较长的医疗延误和总诊断延误有关，也与较高的重症疟疾风险有关。看来有必要重新设计培训计划，以提高医疗保健专业人员的知识水平，并采取针对旅行者的行动，促进他们及时寻求医疗保健建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.