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

DOI 10 References
  • Suzuki Kozue
    Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital Department of Emergency Medicine, Yokohama City Minato Red Cross Hospital
  • Takei Tetsuhiro
    Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital
  • Ito Toshitaka
    Department of Emergency Medicine, Yokohama City Minato Red Cross Hospital
  • Takemoto Masaaki
    Department of Emergency Medicine, Yokohama City Minato Red Cross Hospital
  • Fujisawa Michiko
    Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital

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  • 救急外来受診を契機に診断されたがん症例の検討

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Background: 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.<BR>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.<BR>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).<BR>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.

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