Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
National Institute of General Medical Sciences, Office of Emergency Care Research, Bethesda, Maryland.
JAMA Oncol. 2017 Oct 12;3(10):e172450. doi: 10.1001/jamaoncol.2017.2450.
The emergency department (ED) is used to manage cancer-related complications among the 15.5 million people living with cancer in the United States. However, ED utilization patterns by the population of US adults with cancer have not been previously evaluated or described in published literature.
To estimate the proportion of US ED visits made by adults with a cancer diagnosis, understand the clinical presentation of adult patients with cancer in the ED, and examine factors related to inpatient admission within this population.
DESIGN, SETTING, AND PARTICIPANTS: Nationally representative data comprised of 7 survey cycles (January 2006-December 2012) from the Nationwide Emergency Department Sample were analyzed. Identification of adult (age ≥18 years) cancer-related visits was based on Clinical Classifications Software diagnoses documented during the ED visit. Weighted frequencies and proportions of ED visits among adult patients with cancer by demographic, geographic, and clinical characteristics were calculated. Weighted multivariable logistic regression was used to examine the associations between inpatient admission and key demographic and clinical variables for adult cancer-related ED visits.
Adult cancer-related ED utilization patterns; identification of primary reason for ED visit; patient-related factors associated with inpatient admission from the ED.
Among an estimated 696 million weighted adult ED visits from January 2006 to December 2012, 29.5 million (4.2%) were made by a patient with a cancer diagnosis. The most common cancers associated with an ED visit were breast, prostate, and lung cancer, and most common primary reasons for visit were pneumonia (4.5%), nonspecific chest pain (3.7%), and urinary tract infection (3.2%). Adult cancer-related ED visits resulted in inpatient admissions more frequently (59.7%) than non-cancer-related visits (16.3%) (P < .001). Septicemia (odds ratio [OR], 91.2; 95% CI, 81.2-102.3) and intestinal obstruction (OR, 10.94; 95% CI, 10.6-11.4) were associated with the highest odds of inpatient admission.
Consistent with national prevalence statistics among adults, breast, prostate, and lung cancer were the most common cancer diagnoses presenting to the ED. Pneumonia was the most common reason for adult cancer-related ED visits with an associated high inpatient admission rate. This analysis highlights cancer-specific ED clinical presentations and the opportunity to inform patient and system-directed prevention and management strategies.
美国有 1550 万癌症患者，急诊科用于治疗其中的癌症相关并发症。然而，美国癌症患者群体在急诊科的就诊模式尚未在已发表的文献中进行评估或描述。
评估美国成年人癌症诊断相关急诊科就诊比例，了解成年癌症患者在急诊科的临床表现，并研究该人群中与住院相关的因素。
设计、地点和参与者：利用全国急诊样本中包含的 7 个调查周期（2006 年 1 月至 2012 年 12 月）的全国代表性数据进行分析。根据急诊科就诊期间记录的临床分类软件诊断，确定成年（年龄≥18 岁）癌症相关就诊。根据人口统计学、地理位置和临床特征，计算成年癌症患者在急诊科就诊的加权频率和比例。采用加权多变量逻辑回归分析成年癌症相关急诊科就诊与住院相关的关键人口统计学和临床变量之间的关系。
成年癌症相关急诊科就诊模式；确定急诊科就诊的主要原因；与成年癌症相关急诊科就诊患者相关的住院因素。
在 2006 年 1 月至 2012 年 12 月期间，估计有 6.96 亿次加权成年急诊科就诊，其中 2950 万人次（4.2%）由癌症诊断患者就诊。与急诊科就诊最相关的癌症是乳腺癌、前列腺癌和肺癌，最常见的就诊原因是肺炎（4.5%）、非特异性胸痛（3.7%）和尿路感染（3.2%）。与非癌症相关就诊相比，成年癌症相关急诊科就诊更常导致住院（59.7% vs 16.3%）（P < .001）。败血症（比值比[OR]，91.2；95%CI，81.2-102.3）和肠梗阻（OR，10.94；95%CI，10.6-11.4）与最高的住院入院几率相关。
与成年人的全国流行率统计数据一致，乳腺癌、前列腺癌和肺癌是最常见的癌症诊断。肺炎是成年癌症相关急诊科就诊的最常见原因，住院率较高。该分析突出了癌症特异性急诊科临床表现，并为患者和系统导向的预防和管理策略提供了信息。
