Minimizing the Diagnostic Delay in Amyotrophic Lateral Sclerosis: The Role of Nonneurologist Practitioners

Table 1

Diagnostic delay and intermediate delays of amyotrophic lateral sclerosis in the medical literature.

Reference	Country	Number of patients	Diagnostic delay		Intermediate delays
			Median (months)	Average (months)	Median (months)	Average (months)
Belsh and Schiffman [19]	USA	64	—	12.3	—	A-B (5.9)
Brooks [11]	USA	34	—	21.9	—	C-E (8.7)
Chiò [22]	International	201	14	17–21	A-B (2); B–C (6); C-E (4)	A-B (5.6); B–C (6); C-E (7)
Househam and Swash [20]	UK	57	—	16.2	A-B (3); B–C (5); C-E (2)	A-B (5.2); B–C (7.2); C-E (3.8)
Traynor et al. [23]	Ireland	388	8	—	—	—
Iwasaki et al. [24]	Japan	117	—	11.7–12.7	—	A-B (5.7); A-C (9.7)
Chiò et al. [25]	Italy	221	—	11.1	—	—
Zoccolella et al. [18]	Italy	130	9.3	—	—	—
Czaplinski et al. [26]	USA	1041	13–14.2	—	—	—
Torny et al. [10]	France	77	7	11.7	A-B (2); B–C (3)	A-B (4.7); B–C (6.9)
Donaghy et al. [17]	Northern Ireland	73	15.6	—	A-B (3.1); B–C (5.2); C-E (1.9)	—
Chiò et al. [27]	Italy	1260	—	10.4	—	—
Kraemer et al. [28]	Germany	100	—	13.7	—	—
Mitchell et al. [16]	England	640	11.4	—	—	—
Turner et al. [29]	Ireland	49	9–15	10–22	—	—
Logroscino et al. [6]	Europe	1028	8.7	12.2	—	—
Cellura et al. [30]	Italy	260	11	—	A-B (3); B–C (3); C-E (5)	—
Williams et al. [31]	USA	272	27	—	—	—
Nzwalo et al. [32]	Portugal	101	9.5	10.1	A-B (2); A-C (6)	—
Paganoni et al. [33]	USA	304	11.5	—	A-B (4); B-D^0 (3) – D^0-E (1)	—
Scialo et al. [21]	Italy	298	10	14.3	—	—
Knibb et al. [34]	England	575	11.1	—	—	—
Stevic et al. [35]	Serbia	325	—	19.2	—	—
Yates and Rafiq [36]	Europe	512	—	9.5	—	—
Calvo et al. [1]	Italy	2648	14.2–15	—	—	—
Galvin et al. [37]	Ireland	155	11	15.1	A-B (3)	A-B (5.2); B–C (6.1); C-E (3.8)
Our study	France	90	12	17	A-B (1.1); B–C (4); A-D^0 (0); C-D^0 (0); D^0-E (0.2)	A-B (2.7); B–C (6.5); A-D^0 (2.1); C-D^0 (1.3); D^0-E (2.9)
Average		408.1	12.1	14.2	A-B (2.6); B–C (4.4); C-E (3.2)	A-B (5); B–C (6.5); C-E (5.8)
Range		34–2648	7–27	9.5–21	A-B (1.1-4); B–C (3-6); C-E (1.9-5)	A-B (2.7-5.9); B–C (6-7.2); C-E (3.8-8.7)

A-B = delay of complaint; A-C = delay for a neurologist consultation since the first symptom of the patient; A-D⁰ = delay of the first suspicion of ALS since the first symptom of the patient; B–C = delay for a neurologist consultation since the first complaint of the patient; B-D⁰ = delay of the first suspicion of ALS since the first complaint of the patient; C-D⁰ = delay to perform electroneuromyography; C-E = delay for the neurologist to make the diagnosis of ALS; D⁰-E = delay for diagnosis confirmation.