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Missed opportunities to facilitate the diagnosis of colon cancer in emergency department patients
Critical Care volume 12, Article number: P355 (2008)
We have been aware that colon cancer in our public institution is too often diagnosed at a late stage. We evaluated the pattern of visits of these patients to the emergency department (ED) prior to the diagnosis of cancer.
All patients in the hospital cancer registry with a diagnosis of colon cancer between January 2001 and December 2004 were evaluated. The prior ED visits were tracked in the searchable ED electronic medical record back to January 1999. Chief complaints and hematocrits were recorded. Anemia was defined as a hematocrit <37%. Symptoms were unexplained anorectal or abdominal pain or bleeding, chronic constipation, diarrhea or vomiting.
Two hundred and thirteen patients (116 men and 97 women) with colon cancer diagnosed during the 3-year period had visited the ED at least once prior to diagnosis. 37.6% were diagnosed within 1 week of the first symptomatic ED visit and 50% within the first 40 days. The median time to diagnosis after the first symptomatic ED visit was 46 days while the average was 256 days. Diagnoses were delayed more than 1 year in 51 patients. The median time to diagnosis after the first detection of anemia was 84 days. Forty-one patients were diagnosed at greater than 1 year. Women with anemia (n = 27) were nearly twice as likely as men (n = 16) to have ≥ 1-year delays in diagnosis following the detection of anemia.
Opportunities to facilitate early diagnosis of colon cancer were missed in some cases. Focused interaction of ED providers with outpatient care providers to facilitate evaluation of – suspected colon cancer is necessary to improve early detection. Women with anemia are less likely to be evaluated for a gastrointestinal source of blood loss.
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Delaney, K. Missed opportunities to facilitate the diagnosis of colon cancer in emergency department patients. Crit Care 12, P355 (2008). https://doi.org/10.1186/cc6576
- Emergency Department
- Colon Cancer
- Electronic Medical Record