Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
Department of Mathematics & Statistics, University of Strathclyde, Glasgow, UK.
Clin Otolaryngol. 2021 May;46(3):562-569. doi: 10.1111/coa.13712. Epub 2021 Jan 18.
Current UK referral criteria stipulate that hoarseness should be persistent to merit 2 week wait (2WW) or urgent suspicion of cancer (USOC) referral. This study delineates patterns of hoarseness presentation with a view to assisting referral pathways, and whereby reassurance could be provided.
A pre-existing database of patients referred with hoarseness under the urgent suspicion of cancer (USOC) category was analysed. Univariate and multivariate analyses were performed on a variety of demographic and comorbid features to produce odds ratios (OR) of features either related or not related to laryngeal cancer.
Of 698 consecutive hoarseness referrals were studied. In these referrals there were 506(73%) with persistent hoarseness and 192(27%) with intermittent hoarseness. The most significant patient variables related to laryngeal cancer were persistent hoarseness (OR 4.97), recreational drug use (OR 4.94), male gender (OR 4.01) and weight loss (OR 3.75). Significant patient variables present not related to laryngeal cancer diagnosis were intermittent hoarseness (OR 0.2), the presence of cough (OR 0.2), globus sensation (OR 0.25) and recent viral infection (OR 0.29).
The strongest association with cancer is seen in patients that are persistently hoarse. Patients with fluctuating hoarseness do not need an "urgent suspicion of cancer" referral. Additional demographic referral information could help to streamline the referral of these patients, and reassure others.
目前英国的转诊标准规定，持续性声音嘶哑需要进行 2 周等待（2WW）或疑似癌症紧急转诊（USOC）。本研究描述了声音嘶哑的表现模式，以期协助转诊途径，并提供相应的安抚。
对因疑似癌症紧急转诊（USOC）而就诊的患者进行了一项预先存在的数据库分析。对各种人口统计学和合并症特征进行单变量和多变量分析，以产生与喉癌相关或不相关的特征的优势比（OR）。
在 698 例连续的声音嘶哑转诊中，有 506 例（73%）为持续性嘶哑，192 例（27%）为间歇性嘶哑。与喉癌最显著相关的患者变量是持续性嘶哑（OR 4.97）、滥用药物（OR 4.94）、男性（OR 4.01）和体重减轻（OR 3.75）。与喉癌诊断不相关的显著患者变量为间歇性嘶哑（OR 0.2）、咳嗽（OR 0.2）、球感（OR 0.25）和近期病毒感染（OR 0.29）。
与癌症的最强关联见于持续性嘶哑的患者。声音嘶哑波动的患者不需要进行“疑似癌症紧急转诊”。额外的人口统计学转诊信息可以帮助简化这些患者的转诊流程，并为其他人提供安抚。
