Don't wait for a sensory level--listen to the symptoms: a prospective audit of the delays in diagnosis of XXXX .

@entity1 @entity5 @entity602 @entity3002 @entity425 @entity1745 @entity158
AIM: To report details concerning symptoms ( @entity158 ) preceding the development of @entity1745 ( @entity1745 ); delays between onset/reporting of symptoms and confirmed diagnosis of @entity1745 ; accuracy of investigations carried out. METHODS: A prospective observational study examined the diagnosis, management and outcome of 319 @entity1 diagnosed with @entity1745 at three Scottish @entity5 centres between January 1998-April 1999. The process was considered from the perspectives of the @entity1 , the GP and the hospital doctor. RESULTS: At diagnosis, most @entity1 (82%) were either unable to walk or only able to do so with help. @entity158 was reported by nearly all @entity1 interviewed (94%) and had been present for approximately 3 months (median=90 days). It was severe in 84% of cases, with the distribution and characteristics of nerve @entity158 in 79%. The site of @entity158 did not correspond to the site of compression. Where reported, @entity425 had been noticed by the @entity1 for some time before diagnosis (median intervals 20 and 12 days, respectively). Most @entity1 reported early symptoms to their General Practitioner (GP) and diagnosis was established, following referral and investigation, approximately 2 months (median=66 days) later. CONCLUSION: @entity1 who develop spinal metastases are at risk of irreversible @entity602 . @entity425 and @entity3002 are reported late and identified even later, despite @entity1 having reported @entity158 for a considerable time. @entity1 with @entity5 who describe severe back or spinal nerve @entity158 need urgent assessment on the basis of their symptoms, as signs may occur too late. Plain films and bone scans requested for @entity1 in this audit predicted accurately the level of compression in only 21% and 19% of cases, respectively. The only accurate investigation to establish the presence and site of a compressive lesion is magnetic resonance imaging (MRI). A referral guideline based on suspicious symptoms in addition to suspicious signs is suggested.
