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However, mature gametocytes responsible for transmission of the disease can be present on first presentation and last for several weeks even with artemisinin-based combination therapy (ACT).
Only one patient had deep vein thrombosis on first presentation of ALL (lymphocytic blasts 45 G/l, platelets 265 G/l), whereas the great majority of VTE occurred during therapy (82%).
Nowak et al. [11] have determined predicting factors on first presentation with regard to sequelae.
Edwards and Jupiter [18] also pointed to the high risk of underdiagnosing the Essex-Lopresti lesions on first presentation.
In addition, nodal metastases have been reported in 50% of patients with papillary thyroid cancer on first presentation [32].
Representing an unclassifiable Monteggia variant-type injury, our patient's initial forecast did not bode well on first presentation.
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On second presentation to the ED, the patient was now tachycardic (112 bpm) with blood pressure reduction to 111/64 mmHg.
We found moderate agreement on reported date of first presentation of symptoms to the GP, meaning that the disagreement in reported patient interval is related to date of first symptom rather than date of first presentation to the GP.
In common with case-note audit, there are limitations in deriving information on time points, such as date of first symptom from analysis of databases, although both audit and database analysis can be useful in deriving information on the date of first presentation.
The cases of deep SWI were classified in accordance with the Oakley classification of mediastinitis; there were four subtypes based on the time of first presentation, the presence or absence of risk factors, and whether previous attempts at treating the condition had failed [ 2].
There was some evidence to suggest that the setting of first presentation impacts on delay, with those who presented first to hospital doing so after shorter symptom duration (Wile et al, 1993; Mariscal et al, 2001) (Table 2).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com