Fingland P, Carswell V, Tikka T, Douglas C M, Montgomery J
Department of Otolaryngology,Head and Neck Surgery,Queen Elizabeth University Hospital,Glasgow,Scotland,UK.
J Laryngol Otol. 2018 May;132(5):434-438. doi: 10.1017/S0022215118000282. Epub 2018 Apr 30.
In Scotland, patients with suspected head and neck cancer are referred on the basis of the Scottish Referral Guidelines for Suspected Cancer, rather than the National Institute for Health and Care Excellence guidelines. A chest X-ray should be requested by the general practitioner at the same time as referral for persistent hoarseness. The evidence for this is level 4.
This audit identified adherence to this recommendation and X-ray results. All 'urgent suspicion of cancer' referrals to the ENT department in the National Health Service Greater Glasgow and Clyde for 2015-2016 were audited.
Persistent hoarseness for more than 3 weeks instigated referral in 318 patients (15.7 per cent). Chest X-ray was performed in 120 patients (38 per cent), which showed: no abnormality in 116 (96.7 per cent), features of infection in 2 (1.7 per cent) and something else in 2 patients (1.7 per cent). No chest X-ray altered the management of a patient.
Performance of chest X-ray does not alter management and its removal from the Scottish Referral Guidelines for Suspected Cancer is recommended.
在苏格兰，疑似头颈癌患者是依据《苏格兰疑似癌症转诊指南》而非英国国家卫生与临床优化研究所的指南进行转诊的。全科医生在转诊持续性声音嘶哑患者时应同时要求进行胸部X光检查。此建议的证据等级为4级。
本次审核确定了对该建议的遵守情况及X光检查结果。对2015 - 2016年期间向大格拉斯哥和克莱德国民保健服务局耳鼻喉科转诊的所有“高度疑似癌症”病例进行了审核。
318例患者（15.7%）因持续性声音嘶哑超过3周而被转诊。120例患者（38%）进行了胸部X光检查，检查结果显示：116例（96.7%）无异常，2例（1.7%）有感染特征，2例患者（1.7%）有其他情况。没有胸部X光检查结果改变患者的治疗方案。
胸部X光检查并未改变治疗方案，建议将其从《苏格兰疑似癌症转诊指南》中删除。
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