Causes and consequences of diagnostic delay in Guillain-Barré syndrome in a UK tertiary center.

Introduction/aims: Understanding the potential causes and consequences of diagnostic delay in Guillain-Barré syndrome (GBS) could improve quality of care and outcomes. We aimed to determine these causes and consequences in our cohort of patients with GBS.

Methods: We retrospectively reviewed records of subjects with GBS, admitted to our center at University Hospitals Birmingham, UK, between January 2005 and December 2020. We evaluated time to diagnosis from presentation, factors associated with diagnostic delay, and its potential consequences.

Results: We included 119 consecutive subjects. Diagnostic delay at least 5 days from first presentation occurred in 27 of 119 (22.7%) of patients. Diagnostic delay was associated with age >60 years (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.44-8.85), pre-existing cardiac/respiratory disease (OR, 4.10; 95% CI, 1.46-11.54), pre-existing diabetes (OR, 10.38; 95% CI, 2.47-43.69), documented normal initial neurological examination (OR, 2.49; 95% CI, 1.03-6.02), initial assessment by primary care (OR, 3.33; 95% CI, 1.22-9.10) and at least one visit for medical attention (OR, 10.29; 95% CI, 3.81-27.77). Diagnostic delay was not associated with length of inpatient stay, intensive care unit admission, ventilation, ability to walk at discharge, or inpatient mortality. Independent associations with diagnostic delay were observed for at least one visit for medical attention (OR, 10.15; 95% CI, 3.64-28.32) and pre-existing cardiac/respiratory disease (OR, 3.98; 95% CI, 1.19-13.28). An association of diagnostic delay with inpatient mortality was ascertained specifically in subjects with classic GBS (OR, 5.33; 95% CI, 1.1-25.87).

Discussion: Diagnostic delay in GBS results from patient-specific factors and patient pathways. A high index of suspicion is appropriate for certain patient groups. Prospective studies are needed to further investigate this topic.