Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
BMC Gastroenterol. 2024 Aug 26;24(1):286. doi: 10.1186/s12876-024-03365-x.
To investigate the effect of different working periods on missed diagnoses in patients with colorectal polyps in colonoscopy.
We conducted a retrospective analysis of patients who were diagnosed with colorectal polyps during colonoscopy in an outpatient department between July and December 2022. These patients were subsequently hospitalized for resection during this period. Patients with missed diagnoses were those who had newly discovered polyps in a second colonoscopy. The working periods were categorized as work, near the end of work, and delayed work, respectively, in the morning and afternoon.
A total of 482 patients were included, and the miss rate of diagnosis was 48.1% (232/482), mainly in the transverse colon (25%), and the ascending colon (23%). Patient age was a risk factor for the miss rate of diagnosis (OR = 1.025, 95%CI: 1.009-1.042, P = 0.003) and was also associated with the number of polyps detected for the first colonoscopy (χ = 18.196, P = 0.001). The different working periods had no statistical effect on the missed rate of diagnosis (χ = 1.998, P = 0.849). However, there was an increasing trend in miss rates towards the end of work and delayed work periods, both in the morning and afternoon. The highest miss rate (60.0%) was observed during delayed work in the afternoon. Additionally, poor bowel preparation was significantly more common during delayed work in the afternoon.
The increasing trend in miss rates towards the end of work and delayed work periods deserves clinical attention. Endoscopists cannot always stay in good condition under heavy workloads.
研究不同工作时段对结肠镜检查中结直肠息肉漏诊的影响。
我们对 2022 年 7 月至 12 月期间在门诊行结肠镜检查诊断为结直肠息肉并在此期间住院切除的患者进行了回顾性分析。将第二次结肠镜检查中新发现的息肉定义为漏诊。将工作时段分为上午和下午的工作时段、接近工作结束时段和延迟工作时段。
共纳入 482 例患者，诊断漏诊率为 48.1%（232/482），主要位于横结肠（25%）和升结肠（23%）。患者年龄是漏诊率的危险因素（OR=1.025，95%CI：1.009-1.042，P=0.003），也与首次结肠镜检查发现的息肉数量有关（χ²=18.196，P=0.001）。不同的工作时段对漏诊率无统计学影响（χ²=1.998，P=0.849）。然而，上午和下午接近工作结束和延迟工作时段的漏诊率均呈上升趋势。下午延迟工作时漏诊率最高（60.0%）。此外，下午延迟工作时肠道准备不良的情况更为常见。
接近工作结束和延迟工作时段漏诊率呈上升趋势值得临床关注。内镜医师在高工作量下不能始终保持良好状态。
