Eccersley A James, Wilson Elena M, Makris Andreas, Novell J Richard
Luton & Dunstable Hospital, Bedfordshire, UK.
Ann R Coll Surg Engl. 2003 Mar;85(2):107-10. doi: 10.1308/003588403321219885.
Urgent referral guidelines for patients with suspected colorectal cancer were introduced in 2000. In a district general hospital, we prospectively assessed the effect of these guidelines on the number of urgent referrals received and the number found to have cancer.
Over the first year, 180 urgent referrals were received of whom 95 (55%) fitted the guidelines. Of these 95 patients, 24 (25%) had colorectal cancer. Conversely, only 2 of the 85 patients (2%) who did not fit the guidelines had colorectal cancer. During the same time period, a total of 145 new cancers were identified within the district of which 119 (82%) were in patients who had not been urgently referred to out-patients as suspected colorectal cancer.
The guidelines are effective in that patients who fit them have a significant chance of having colorectal cancer. However, the majority of cancers are identified outside the new system. Efforts to reduce delays in diagnosis need to recognise that many patients do not have features which fit published referral criteria. Improved support for general practitioners and better access to specialist services are required to reduce delays in diagnosis.
2000年出台了疑似结直肠癌患者的紧急转诊指南。在一家区综合医院，我们前瞻性地评估了这些指南对紧急转诊数量以及确诊癌症数量的影响。
在第一年，共收到180例紧急转诊，其中95例（55%）符合指南。在这95例患者中，24例（25%）患有结直肠癌。相反，在不符合指南的85例患者中，只有2例（2%）患有结直肠癌。在同一时期，该地区共确诊145例新癌症病例，其中119例（82%）患者并非作为疑似结直肠癌紧急转诊至门诊。
这些指南是有效的，因为符合指南的患者患结直肠癌的可能性很大。然而，大多数癌症是在新系统之外确诊的。减少诊断延误的努力需要认识到，许多患者没有符合已公布转诊标准的特征。需要加强对全科医生的支持并改善专科服务的可及性，以减少诊断延误。
