On 2016 Mar 03, Farrel Buchinsky commented:

An interesting article about 21 children noting that there was a correlation between the number of surgeries and the preceding delay between symptoms developing and a diagnosis being made. This finding would be compatible with the possibility that the longer one delays the more a child is likely to need more surgeries. If that is true then that should encourage us to make the diagnosis as soon as possible so that we can operate as soon as possible and so that the child could undergo fewer surgeries rather than more surgeries. Given that this was not a randomized trial would the data also be compatible with another possibility? Could it be that children with the least delay may have gone into spontaneous remission had their delay continued and they had undergone no surgery?

Two other observations struck me when I looked at the data. There was a statistically significant association between the age of symptom onset and the time between symptom onset and diagnosis. Children whose symptoms began before they were 5.5 y (66 months) had a median delay of 33 months and the children who were older than 5.5 y when their symptoms began had a median delay of 3.5 months. Many case series have demonstrated an association between younger age being associated with a more aggressive clinical course presumably resulting in greater number of surgeries. That was not seen in this group of 21 patients.

Can you please check the statement, "The average time from symptom onset to diagnosis was 52.3 months". I calculate it to be 20.3 months. I used the following values: 1 3 24 7 33 36 48 3 4 4 54 7 21 26 38 3 43 59 1 1 10

On 2016 Mar 03, Farrel Buchinsky commented:

An interesting article about 21 children noting that there was a correlation between the number of surgeries and the preceding delay between symptoms developing and a diagnosis being made. This finding would be compatible with the possibility that the longer one delays the more a child is likely to need more surgeries. If that is true then that should encourage us to make the diagnosis as soon as possible so that we can operate as soon as possible and so that the child could undergo fewer surgeries rather than more surgeries. Given that this was not a randomized trial would the data also be compatible with another possibility? Could it be that children with the least delay may have gone into spontaneous remission had their delay continued and they had undergone no surgery?

Two other observations struck me when I looked at the data. There was a statistically significant association between the age of symptom onset and the time between symptom onset and diagnosis. Children whose symptoms began before they were 5.5 y (66 months) had a median delay of 33 months and the children who were older than 5.5 y when their symptoms began had a median delay of 3.5 months. Many case series have demonstrated an association between younger age being associated with a more aggressive clinical course presumably resulting in greater number of surgeries. That was not seen in this group of 21 patients.

Can you please check the statement, "The average time from symptom onset to diagnosis was 52.3 months". I calculate it to be 20.3 months. I used the following values: 1 3 24 7 33 36 48 3 4 4 54 7 21 26 38 3 43 59 1 1 10