Quick diagnosis units: a potentially useful alternative to conventional hospitalisation

Bosch, Xavier; Aibar, Jesús; Capell, Santiago; Coca, António; López‐Soto, Alfons

doi:10.5694/j.1326-5377.2009.tb02912.x

Cited by 38 publications

(77 citation statements)

References 7 publications

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“…However, at this time in Europe there are no LC screening recommendations though The European Society of Radiology and the European Respiratory Society recommend screening within a clinical trial or in routine clinical practice at certified medical centres6. Instead, the strategy implemented in many European hospitals to achieve an early detection is the acceleration in the time to diagnosis in the so called Rapid Diagnostic Units for LC1011121516. Consequently, we intended to design a marker-based classification algorithm to be used in these Units, where the priority is to detect all LC cases (high sensitivity), in order to select those patients that should be immediately submitted to more invasive tests.…”

Section: Discussionmentioning

confidence: 99%

“…Rapid or Quick Diagnostic Units (RDU/QDU) have been established within the public health system, with the main objective of accelerating the early diagnosis of potentially severe diseases such as cancer, avoiding hospitalisations for purely diagnostic purposes, minimizing hospital-related morbidity, reducing costs, and improving patient satisfaction1516. In Spain approximately 40–50% of the patients attending LC-RDUs display non-cancerous lung pathologies1112.…”

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confidence: 99%

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Highly Sensitive Marker Panel for Guidance in Lung Cancer Rapid Diagnostic Units

Blanco-Prieto

Chiara

Rodríguez-Girondo

et al. 2017

Sci Rep

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While evidence for lung cancer screening implementation in Europe is awaited, Rapid Diagnostic Units have been established in many hospitals to accelerate the early diagnosis of lung cancer. We seek to develop an algorithm to detect lung cancer in a symptomatic population attending such unit, based on a sensitive serum marker panel. Serum concentrations of Epidermal Growth Factor, sCD26, Calprotectin, Matrix Metalloproteinases −1, −7, −9, CEA and CYFRA 21.1 were determined in 140 patients with respiratory symptoms (lung cancer and controls with/without benign pathology). Logistic Lasso regression was performed to derive a lung cancer prediction model, and the resulting algorithm was tested in a validation set. A classification rule based on EGF, sCD26, Calprotectin and CEA was established, able to reasonably discriminate lung cancer with 97% sensitivity and 43% specificity in the training set, and 91.7% sensitivity and 45.4% specificity in the validation set. Overall, the panel identified with high sensitivity stage I non-small cell lung cancer (94.7%) and 100% small-cell lung cancers. Our study provides a sensitive 4-marker classification algorithm for lung cancer detection to aid in the management of suspicious lung cancer patients in the context of Rapid Diagnostic Units.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Highly Sensitive Marker Panel for Guidance in Lung Cancer Rapid Diagnostic Units

Blanco-Prieto

Chiara

Rodríguez-Girondo

et al. 2017

Sci Rep

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“…Whilst inappropriate use of hospital beds surpasses 20% through diverse specialties in Europe, admission for workup is one of the commonest reasons for inappropriate hospitalizations [28,29]. Deficiencies at several levels of the Spanish healthcare system prompted the creation of alternatives to hospitalization, exemplified by hospital-based outpatients’ quick diagnosis units (OQDUs) [23,25,30–33]. Reported advantages over hospitalization are numerous: besides ensuring a time-to-diagnosis similar to the length-of-stay for the same evaluable condition, these clinics decrease emergency department referrals from primary healthcare centers and ease overcrowding, are associated with higher scores of patient reported satisfaction than inpatients, and are significantly cost-saving [31,34–42].…”

Section: Introductionmentioning

confidence: 99%

Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients

et al. 2017

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BackgroundWhereas there are numerous studies on unintentional weight loss (UWL), these have been limited by small sample sizes, short or variable follow‐up, and focus on older patients. Although some case series have revealed that malignancies escaping early detection and uncovered subsequently are exceptional, reported follow-ups have been too short or unspecified and necropsies seldom made. Our objective was to examine the etiologies, characteristics, and long-term outcome of UWL in a large cohort of outpatients.MethodsWe prospectively enrolled patients referred to an outpatient diagnosis unit for evaluation of UWL as a dominant or isolated feature of disease. Eligible patients underwent a standard baseline evaluation with laboratory tests and chest X-ray. Patients without identifiable causes 6 months after presentation underwent a systematic follow-up lasting for 60 further months. Subjects aged ≥65 years without initially recognizable causes underwent an oral cavity examination, a videofluoroscopy or swallowing study, and a depression and cognitive assessment.ResultsOverall, 2677 patients (mean age, 64.4 [14.7] years; 51% males) were included. Predominant etiologies were digestive organic disorders (nonmalignant in 17% and malignant in 16%). Psychosocial disorders explained 16% of cases. Oral disorders were second to nonhematologic malignancies as cause of UWL in patients aged ≥65 years. Although 375 (14%) patients were initially diagnosed with unexplained UWL, malignancies were detected in only 19 (5%) within the first 28 months after referral. Diagnosis was established at autopsy in 14 cases.ConclusionThis investigation provides new information on the relevance of follow-up in the long-term clinical outcome of patients with unexplained UWL and on the role of age on this entity. Although unexplained UWL seldom constitutes a short-term medical alert, malignancies may be undetectable until death. Therefore, these patients should be followed up regularly (eg yearly visits) for longer than reported periods, and autopsies pursued when facing unsolved deaths.

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“…Studies show that anemia and cancer are the most-recorded diagnoses in Spanish QDU patients [4,5,27,28]. Likewise, the main reasons for hospitalization for diagnostic tests in Spain are severe anemia and suspected cancer-related unintentional weight loss [4-6,27-29]. Anemia, with or without symptoms, with hemoglobin levels below 8–9 g/l, has traditionally been a criterion for admission in our hospital [4,6].…”

Section: Discussionmentioning

confidence: 99%

“…However, the unit received patients from 12 PHC centers and the population attended is representative of that of other Spanish QDU, according to published reports [27-29,31,32]. In addition, although the appropriateness of PHC referrals to QDU and ED was objectively assessed using a scoring system, the possibility of some perception bias cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

et al. 2014

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BackgroundIn Spain, primary healthcare (PHC) referrals for diagnostic procedures are subject to long waiting-times, and physicians and patients often use the emergency department (ED) as a shortcut. We aimed to determine whether patients evaluated at a hospital outpatient quick diagnosis unit (QDU) who were referred to ED from 12 PHC centers could have been directly referred to QDU, thus avoiding ED visits. As a secondary objective, we determined the proportion of QDU patients who might have been evaluated in a less rapid, non-QDU setting.MethodsWe carried out a cross-sectional retrospective cohort study of patients with potentially serious conditions attended by the QDU from December 2007 to December 2012. We established 2 groups of patients: 1) patients referred from PHC to QDU (PHC-QDU group) and 2) patients referred from PHC to ED, then to QDU (PHC-ED-QDU group). Two observers assessed the appropriateness/inappropriateness of each referral using a scoring system. The interobserver agreement was assessed by calculating the kappa index. Multivariate logistic regression analysis was performed to identify the factors associated with the dependent variable ‘ED referral’.ResultsWe evaluated 1186 PHC-QDU and 1004 PHC-ED-QDU patients and estimated that 93.1% of PHC-ED-QDU patients might have been directly referred to QDU. In contrast, 96% of PHC-QDU patients were found to be appropriately referred to QDU first. The agreement for PHC-QDU referrals (PHC-QDU group) was rated as excellent (ϰ = 0.81), while it was rated as good for PHC-ED referrals (PHC-ED-QDU group) (ϰ = 0.75). The mean waiting-time for the first QDU visit was longer in PHC-QDU (4.8 days) than in PHC-ED-QDU (2.6 days) patients (P = .001). On multivariate analysis, anemia (OR 2.87, 95% CI 1.49–4.55, P < .001), rectorrhagia (OR 2.18, 95% CI 1.10–3.77, P = .01) and febrile syndrome (OR 2.53, 95% CI 1.33-4.12, P = .002) were independent factors associated with ED referral. Nearly one-fifth of all QDU patients were found who might have been evaluated in a less rapid, non-QDU setting.ConclusionsMost PHC-ED-QDU patients might have been directly referred to QDU from PHC, avoiding the inconvenience of the ED visit. A stricter definition of QDU evaluation criteria may be needed to improve and hasten PHC referrals.

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Quick diagnosis units: a potentially useful alternative to conventional hospitalisation

Cited by 38 publications

References 7 publications

Highly Sensitive Marker Panel for Guidance in Lung Cancer Rapid Diagnostic Units

Highly Sensitive Marker Panel for Guidance in Lung Cancer Rapid Diagnostic Units

Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients

Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

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