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Improving recognition of Duchenne muscular dystrophy: a retrospective case note review

Lookup NU author(s): Dr Henriette van Ruiten, Professor Volker Straub, Professor Katherine Bushby, Dr Michela Guglieri

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

Background Over the last 30 years, there has been little improvement in the age of diagnosis of Duchenne muscular dystrophy (DMD) (mean age of 4.5-4.11 years).Aim To review the diagnostic process for DMD in boys without a family history in order to identify where delays occur and suggest areas for improvement.Design A retrospective case note review.Setting A tertiary centre for neuromuscular diseases in England.Patients All boys without family history diagnosed with DMD in the last 10 years (n=20).Outcome measures Mean age at four key steps in the diagnostic pathway of DMD.Results (1) Age at first reported symptoms of DMD was 32.5 (8-72) months (2.7 years). (2) First engagement of a healthcare professional was at 42.9 (10-90) months. (3) Creatine kinase (CK) levels were checked at 50.1 (14-91) months. (4) Diagnosis of DMD was confirmed at 51.7 (16-91) months (4.3 years). The total delay from parental concern to diagnosis was 19.2 (4-50) months (1.6 years).Conclusions Our study shows an improvement in the age of diagnosis of DMD although there continues to be a delay in presentation to a health professional and a delay in obtaining a CK test. To reduce these delays, we propose screening for DMD as part of the Child Health Surveillance Programme, in addition to lowering the threshold for CK testing in primary care by promoting a new DMD mnemonic MUSCLE. An earlier diagnosis of DMD will allow timely access to genetic counselling, standards of care and clinical trials.


Publication metadata

Author(s): van Ruiten HJA, Straub V, Bushby K, Guglieri M

Publication type: Article

Publication status: Published

Journal: Archives of Disease in Childhood

Year: 2014

Volume: 99

Issue: 12

Pages: 1074-1077

Print publication date: 01/12/2014

Online publication date: 03/09/2014

Acceptance date: 04/08/2014

Date deposited: 16/09/2015

ISSN (print): 0003-9888

ISSN (electronic): 1468-2044

Publisher: BMJ Publishing Group

URL: http://dx.doi.org/10.1136/archdischild-2014-306366

DOI: 10.1136/archdischild-2014-306366

PubMed id: 25187493


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