Department of Emergency Medicine, Virginia Commonwealth University, P.O. Box 980401, 1201 East Marshall Street, Richmond, VA 23298, USA.
Am J Emerg Med. 2012 Feb;30(2):283-92. doi: 10.1016/j.ajem.2010.11.029. Epub 2011 Jan 17.
This study determined the proportion of incident colorectal and lung cancers with a diagnosis associated with an emergency department (ED) visit. The characteristics of these patients and the correlation between diagnosis near an ED visit and stage at diagnosis were also examined.
A population-based sample of all Michigan cancer cases diagnosed in all EDs and other health care settings was used to extract a sample of patients >65 years old, diagnosed with colorectal and lung cancers between January 1, 1996, and June 30, 2000 (n = 20 311). Logistic regressions were used for the statistical analysis.
Patients with a colorectal cancer diagnosis associated with an ED visit were more likely insured by Medicaid before diagnosis (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.17-1.60), had an inpatient admission before diagnosis (OR, 1.29; 95% CI, 1.06-1.56), had 3 or more comorbidities (OR, 4.11; 95% CI, 3.53-4.79), were more likely to be female (OR, 1.18; 95% CI, 1.07-1.31), and were more likely to be aged 85 years and older (OR, 1.89; 95% CI, 1.57-2.27). Patients who had at least one primary care physician (PCP) visit before diagnosis were less likely to have a diagnosis associated with an ED visit (OR, 0.68; 95% CI, 0.61-0.76). Patients diagnosed with lung cancer in association with an ED visit were also more likely to have an inpatient admission before diagnosis (OR, 1.21; 95% CI, 1.02-1.43), a higher comorbidity burden (OR, 12.44; 95% CI, 10.18-15.20), be female (OR, 1.13; 95% CI, 1.02-1.25), African-American (OR, 1.42; 95% CI, 1.21-1.66), and older (80 years and older) (ages 80-84 years: OR, 1.33; 95% CI, 1.13-1.57; age 85 years and older: OR, 1.52; 95% CI, 1.25-1.85). Patients with an ED visit near a colorectal cancer (OR, 1.28; 95% CI, 1.15-1.42) or lung cancer diagnosis (OR, 1.65; 95% CI, 1.44-1.88) were more likely to be diagnosed at a later stage compared with patients diagnosed in other settings.
An examination of patients' patterns of care leading to a cancer diagnosis in association with an ED visit lends insight to conditions precipitating a more immediate diagnosis and their associated outcomes.
本研究旨在确定因急诊就诊而确诊的新发结直肠癌和肺癌病例的比例。本研究还分析了这些患者的特征以及在急诊就诊附近诊断与诊断时分期之间的相关性。
利用密歇根州所有在急诊和其他医疗机构就诊的癌症患者的人群为基础的样本，选取 1996 年 1 月 1 日至 2000 年 6 月 30 日期间年龄在 65 岁以上、确诊为结直肠癌和肺癌的患者（n=20311）。采用逻辑回归进行统计分析。
与急诊就诊相关的结直肠癌诊断患者在诊断前更有可能通过医疗补助计划（Medicaid）获得保险（比值比[OR]，1.37；95%置信区间[CI]，1.17-1.60），在诊断前有住院治疗（OR，1.29；95%CI，1.06-1.56），合并 3 种或以上合并症（OR，4.11；95%CI，3.53-4.79），更有可能为女性（OR，1.18；95%CI，1.07-1.31），且更有可能为 85 岁及以上（OR，1.89；95%CI，1.57-2.27）。在诊断前至少有一次初级保健医生（PCP）就诊的患者不太可能被诊断为与急诊就诊相关的疾病（OR，0.68；95%CI，0.61-0.76）。与急诊就诊相关而被诊断为肺癌的患者，在诊断前也更有可能有住院治疗（OR，1.21；95%CI，1.02-1.43），合并症负担更重（OR，12.44；95%CI，10.18-15.20），为女性（OR，1.13；95%CI，1.02-1.25），为非裔美国人（OR，1.42；95%CI，1.21-1.66），年龄更大（80 岁及以上）（80-84 岁：OR，1.33；95%CI，1.13-1.57；85 岁及以上：OR，1.52；95%CI，1.25-1.85）。与在其他医疗机构就诊相比，因结直肠癌（OR，1.28；95%CI，1.15-1.42）或肺癌（OR，1.65；95%CI，1.44-1.88）就诊而被诊断的患者更有可能处于晚期。
对因急诊就诊而导致癌症诊断的患者的治疗模式进行检查，可以深入了解促使更紧急诊断的情况及其相关结果。
