Khalaf Natalia, Ali Basim, Zimolzak Andrew J, Liu Yan, Kramer Jennifer R, El-Serag Hashem B, Kanwal Fasiha, Singh Hardeep
Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd.152, Houston, TX, 77030, USA.
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Dig Dis Sci. 2025 Jan;70(1):177-190. doi: 10.1007/s10620-024-08762-6. Epub 2024 Dec 11.
Colorectal cancer (CRC) diagnoses are frequently made through emergency presentations (EPs), a new cancer diagnosis following an emergency care episode or unplanned inpatient admission. The extent and implications of EPs are not well known in the Veterans Affairs (VA) health system, where robust CRC screening protocols exist. The impact of the COVID-19 pandemic on the route of CRC diagnosis also remains unclear.
We conducted a retrospective cohort study of all incident CRC cases diagnosed nationally in the VA health care system from 2017 to 2021. We applied a previously validated algorithm to identify CRC EPs and used multivariable logistic regression and Cox proportional hazards models to examine the associations between EPs and CRC stage, treatment, and mortality.
We identified 9,096 patients with CRC, 28.1% of whom had EPs, with the proportion of EPs increasing over the study period from 26.4% in 2017-2019 to 31.4% in 2020-2021. Patients with EPs were more likely to have advanced stage disease (adjusted OR 1.70; 95% CI 1.53-1.88) and less likely to receive cancer treatment (adjusted OR 0.65; 95% CI 0.56-0.75) than patients without EPs. Patients with EPs also had significantly higher mortality risk (adjusted HR 1.70; 95% CI 1.56-1.84).
In a large cohort of patients diagnosed with CRC, we found EPs to be common and independently associated with worse cancer outcomes. EPs also increased during the COVID-19 pandemic. Interventions are needed to reduce potentially avoidable EPs and improve outcomes of patients with CRC diagnosis.
结直肠癌（CRC）的诊断常常通过急诊就诊（EPs）进行，即指在急诊护理事件或非计划住院后做出的新癌症诊断。在拥有完善的CRC筛查方案的退伍军人事务部（VA）医疗系统中，急诊就诊的范围和影响尚不明确。2019年冠状病毒病（COVID-19）大流行对CRC诊断途径的影响也仍不清楚。
我们对2017年至2021年在VA医疗系统中全国范围内诊断出的所有新发CRC病例进行了一项回顾性队列研究。我们应用一种先前验证过的算法来识别CRC急诊就诊病例，并使用多变量逻辑回归和Cox比例风险模型来研究急诊就诊与CRC分期、治疗及死亡率之间的关联。
我们识别出9096例CRC患者，其中28.1%有急诊就诊情况，且急诊就诊的比例在研究期间有所增加，从2017 - 2019年的26.4%增至2020 - 2021年的31.4%。与无急诊就诊的患者相比，有急诊就诊的患者更有可能患有晚期疾病（校正比值比1.70；95%置信区间1.53 - 1.88），且接受癌症治疗的可能性更小（校正比值比0.65；95%置信区间0.56 - 0.75）。有急诊就诊的患者死亡风险也显著更高（校正风险比1.70；95%置信区间1.56 - 1.84）。
在一大群被诊断为CRC的患者中，我们发现急诊就诊情况很常见，且与更差的癌症结局独立相关。在COVID - 19大流行期间急诊就诊情况也有所增加。需要采取干预措施以减少潜在可避免的急诊就诊情况，并改善CRC诊断患者的结局。
