Lana A, Alvarez-Guerrero S, Herrero-Puente P, Folgueras M V, López M L
Facultad de Medicina y Ciencias de la Salud, Oviedo, 33006, Spain.
An Sist Sanit Navar. 2014 Jan-Apr;37(1):59-67. doi: 10.4321/s1137-66272014000100007.
To measure the frequency, trends and distribution of cancers with suspected diagnosis in the Hospital Emergency Services (HES) in Asturias during 2006-12. To describe the clinical characteristics of these cancers and to determine if they differ from those whose diagnosis is made in other services.
Population based descriptive study of cancers registered in the Hospital Tumour Registry of Asturias (Spain), which provided data of patient characteristics, cancer variables (site, histology, stage, metastasis and delay), the hospital and service of diagnosis. Patients with confirmed diagnosis of cancer (non-melanoma of skin excluded) in the study period were included (N=26,020). Differences of cancer cases according to the service that had performed the suspected diagnosis were analyzed. We performed regression analysis of the time between the first symptom and the suspected diagnosis, the definitive diagnosis and treatment, controlling main confounders.
Seven point nine percent (n=2,056) of all cancer cases were suspected in a HES (annual minimum of 5.3% and maximum 10.4%, with an upward trend). These patients were mainly men (60.6%), with a mean age of 67.7 years, and with lung (21.0%) and colon cancer (15.5%). The HES ranks 6th place in the list of services which diagnosed cancer. There was more diagnosis of advanced tumours (33.0%) and metastasis (29.5%) in the HES. The HES halved the time between the first symptom and the SD (-63.3 days; p<0.001), and between definitive diagnosis and initiation of treatment (-15.9 days; p<0.001) compared to the other services.
The HES contribute significantly to suspected cancer diagnosis, mainly advanced and metastatic tumours in the respiratory and digestive system, whose symptoms escape accidental diagnosis conducted in primary care, and they start abruptly.
旨在测量2006 - 2012年期间阿斯图里亚斯医院急诊服务（HES）中疑似癌症诊断的频率、趋势和分布情况。描述这些癌症的临床特征，并确定它们与在其他科室确诊的癌症是否存在差异。
基于人群的描述性研究，对象为西班牙阿斯图里亚斯医院肿瘤登记处登记的癌症患者，该登记处提供了患者特征、癌症变量（部位、组织学、分期、转移和延误情况）、诊断医院和科室等数据。纳入研究期间确诊为癌症（不包括皮肤非黑色素瘤）的患者（N = 26,020）。分析根据进行疑似诊断的科室不同的癌症病例差异。我们对首次症状出现与疑似诊断、确诊诊断及治疗之间的时间进行回归分析，并控制主要混杂因素。
所有癌症病例中有7.9%（n = 2,056）在HES中被疑似诊断（年度最低为5.3%，最高为10.4%，呈上升趋势）。这些患者主要为男性（60.6%），平均年龄67.7岁，以肺癌（21.0%）和结肠癌（15.5%）为主。HES在癌症诊断科室中排名第6。HES中晚期肿瘤（33.0%）和转移瘤（29.5%）的诊断更多。与其他科室相比，HES将首次症状出现与疑似诊断之间的时间减半（-63.3天；p < 0.001），确诊诊断与开始治疗之间的时间也减半（-15.9天；p < 0.001）。
HES对疑似癌症诊断有显著贡献，主要是呼吸和消化系统的晚期及转移性肿瘤，其症状易被初级保健中的偶然诊断遗漏，且起病突然。
