PMID- 34369599
OWN - NLM
STAT- MEDLINE
DCOM- 20220217
LR  - 20230202
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Print)
IS  - 0023-852X (Linking)
VI  - 132
IP  - 2
DP  - 2022 Feb
TI  - Delayed Diagnosis of Idiopathic Subglottic Stenosis.
PG  - 413-418
LID - 10.1002/lary.29783 [doi]
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.
CI  - (c) 2021 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Berges, Alexandra J
AU  - Berges AJ
AUID- ORCID: 0000-0002-0890-6291
AD  - Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, U.S.A.
FAU - Lina, Ioan A
AU  - Lina IA
AUID- ORCID: 0000-0002-8619-7312
AD  - Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, U.S.A.
FAU - Chen, Lena
AU  - Chen L
AUID- ORCID: 0000-0001-9814-7745
AD  - Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, U.S.A.
FAU - Ospino, Rafael
AU  - Ospino R
AUID- ORCID: 0000-0002-8501-1934
AD  - Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, U.S.A.
FAU - Davis, Ruth
AU  - Davis R
AUID- ORCID: 0000-0001-9592-932X
AD  - Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, U.S.A.
FAU - Hillel, Alexander T
AU  - Hillel AT
AUID- ORCID: 0000-0001-8471-5449
AD  - Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, U.S.A.
LA  - eng
GR  - R01 DC018567/DC/NIDCD NIH HHS/United States
GR  - R21 DC017225/DC/NIDCD NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20210809
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Adult
MH  - *Delayed Diagnosis
MH  - Female
MH  - Humans
MH  - Laryngostenosis/*diagnosis
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
PMC - PMC8742746
MID - NIHMS1726540
OTO - NOTNLM
OT  - Idiopathic subglottic stenosis (iSGS)
OT  - delayed diagnosis
OT  - laryngotracheal stenosis (LTS)
OT  - subglottic stenosis (SGS)
OT  - tracheal stenosis
COIS- Disclosures: Dr. Hillel has a sponsored research agreement with Medtronic to 
      investigate tracheostomy tube injury to the trachea. The remaining authors have 
      no other funding, financial relationships, or conflicts of interest to disclose.
EDAT- 2021/08/10 06:00
MHDA- 2022/02/19 06:00
PMCR- 2023/02/01
CRDT- 2021/08/09 08:57
PHST- 2021/06/04 00:00 [revised]
PHST- 2021/03/22 00:00 [received]
PHST- 2021/07/14 00:00 [accepted]
PHST- 2021/08/10 06:00 [pubmed]
PHST- 2022/02/19 06:00 [medline]
PHST- 2021/08/09 08:57 [entrez]
PHST- 2023/02/01 00:00 [pmc-release]
AID - 10.1002/lary.29783 [doi]
PST - ppublish
SO  - Laryngoscope. 2022 Feb;132(2):413-418. doi: 10.1002/lary.29783. Epub 2021 Aug 9.