Background:
Historically the identification of ACL injuries upon initial presentation is low and
considerable diagnostic delays have been reported. However, specific evidence
on the individual elements of, and factors which influence delay, is lacking.
Aims:
The overarching aim was to provide a comprehensive picture of delay to
diagnosis and specialist consultation, including factors which influence delay.
An additional aim was to determine whether the approach to examining acute
knee injuries varied as a consequence of varying patient presentation or
experience of the assessing clinician.
Methods:
Study 1: Cross -sectional survey.
Study 2: Non-participant direct observation methodology.
Results:
Data from 194 patients were analysed in the survey. Only 15.5% of patients
were given a correct diagnosis of ACL rupture at the initial consultation. Median delay to diagnosis was 67.5 days (IQR= 15 to 178 days) and specialist
consultation 108 days (IQR= 38 to 292 days). The factors most influential on
delay were whether a follow-up appointment was arranged after attending A&E,
whether the site of attendance operated an acute knee clinic and whether MRI
was performed.
The direct observation study showed wide variation in approach to injury
assessment. Specialist clinicians performed the most comprehensive
examination. A&E clinicians were more likely to assess for bony, neurovascular
and gross tendon injuries as opposed to ligamentous or meniscal injury.
Conclusions:
The diagnostic rate of ACL injury at initial presentation remains low.
Considerable delays to diagnosis and specialist consultation are apparent
following ACL injury, the majority of which is attributable to health system delay.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/14627 |
| Date | January 2016 |
| Creators | Ayre, Colin A. |
| Contributors | Hardy, Maryann L., Scally, Andy J. |
| Publisher | University of Bradford, Faculty of Health Studies |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Thesis, doctoral, PhD |
| Rights | <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. |
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