Clinical Characteristics and Diagnostic Delay in Spinal Tuberculosis Patients in The Netherlands

Introduction: With declining TB incidences diagnostic delays, especially in extra-pulmonary TB, may increase. We describe the patient and clinical characteristics of patients with spinal TB and assessed the course of diagnostic delays of spinal TB from 2000-2011 in The Netherlands. Methods: Data from the Netherlands Tuberculosis Registry were studied, completed with basic demographic data and data considering patients-, doctors- and total diagnostic delay retrieved from the patient records at the public municipal health services. Results: A total of 274 cases were studied. Median diagnostic delay was five months and stable during this period. Sex and age groups were associated with significant differences in diagnostic delay (male 4.5 vs female 5.5 months), and 4.5-5 months in the youngest age group and persons>65 years but 5.75 months in patients aged 35-64 years. No difference was observed between origin of patients, patients presenting with TB risk factors or with neurological symptoms. Typical TB symptoms at presentation lead, surprisingly, to significantly increased doctors’ delay (typical symptoms 4.0 vs no typical symptoms 2.0 months, p=0.05). Conclusion: Considering spinal TB diagnosis and act expeditious is necessary to limit the time to diagnosis in spinal TB. Refresher courses should be offered both to family physicians and clinical specialists in The Netherlands