Analysis of patients who are diagnosed as having cancer after visiting an emergency department

Abstract

Analysis of patients who are diagnosed as having cancer after visiting an emergency departmentBackground: Although we sometimes encounter cancer diagnosis during the course of diagnostic process after visiting an emergency department (ED), its detailed picture has not been fully clarified. Therefore we examined the incidence rate and the characteristics of patients diagnosed as having cancer after visiting our ED. Method: We retrospectively investigated the medical records of all the adult patients who visited our ED between April and June 2007 (ER group) and extracted the patients with cancer which was newly diagnosed at ED or during the follow-up period. The same method was applied to all the adult patients who visited our outpatient department during April 2007 (control group). Access to our ED, cancer localization, diagnostic examinations, diagnostic process, presented symptoms, treatment, and patient outcome at 6 months were then compared between the two groups. Result: During the study period, 48 of 5,587 patients (0.86%) were diagnosed as having cancer in the ER group, which was approximately one third the incidence rate in the control group (2.32%, p<0.001). Among patients 70 years of age or older, the incidence rate increased to 2.03% and 4.05%, respectively (p=0.04). The most common diagnostic examination among patients who were diagnosed at ED was computed tomography (78%), whereas that among patients who were diagnosed during the follow-up period was digestive tract endoscopy (67%, p<0.001). The most common chief complaint in the ER group was abdominal pain (31%), whereas in the control group, one third visited our hospital asymptomatically (p<0.001). Significantly fewer patients underwent radical therapy in the ER group compared with the control group (46 vs 80%, p=0.035), and survivors at 6 months were also fewer in the ER group (38 vs 60%, p=0.042). Conclusion:Incidence rate of newly diagnosed cancer after visiting our ED was 0.86% among adult patients and 2.03% among patients 70 years of age or older, which seemed not to be negligible. We concluded that cancer should be included in differential diagnosis even for patients presenting in the ED. (JJAAM. 2010; 21: 779-85)

A study of the usefulness of inspection of radiology reports in the emergency room

“…When radiology findings raise the suspicion of a tumor, Suzuki et al reported that the incidence rate of newly diagnosed cancer after visiting the emergency department was 0.86% among adult patients and 2.03% among patients aged 70 years or older. 9 Of these patients, cancer was detected in the abdominal system (65%), respiratory system (13%), urinary system (10%), and others (13%). In our study, when inspection of radiology reports of CT or MRI by emergency doctors was performed after patients went home, there were 51 examinations which included findings to suspect a tumor (11.8% in head, 41.2% in chest, 35.3% in abdomen, and 11.8% in others).When compared with the report of Suzuki et al, findings to suspect a tumor were detected more often not only in abdominal CT but also in chest CT. Detecting non-emergency abnormal findings to suspect a cancer is sometimes difficult.…”

“…When radiology findings raise the suspicion of a tumor, Suzuki et al reported that the incidence rate of newly diagnosed cancer after visiting the emergency department was 0.86% among adult patients and 2.03% among patients aged 70 years or older 9 . Of these patients, cancer was detected in the abdominal system (65%), respiratory system (13%), urinary system (10%), and others (13%).…”