Abstract
Purpose
Patients with colorectal cancer (CRC) who present to the emergency department (ED)
reportedly have poorer prognoses than other referral sources. The purpose of this
study was to compare the clinical presentations and outcomes of patients referred
to the hospital from the ED and those referred from non-ED facilities.
Methods
This retrospective medical record review study was conducted from January 1, 2008,
to December 31, 2008, and comprised patients newly diagnosed as having CRC admitted
to the hospital from the ED or referred from non-ED sources. Patients were admitted
for CRC diagnosis confirmation, staging, and treatment. The staging at diagnosis and
2-year mortality were measured.
Results
Forty-five (29.2%) patients comprised the ED group, and another 109 (70.8%) patients
comprised the non-ED group. Patients in the ED group had significantly longer hospital
stays, greater in-hospital mortality, abdominal pain, intestinal obstruction, complications,
lower hemoglobin levels, and more proximal than rectosigmoid tumor locations compared
with patients referred from other sources. However, there was no statistically significant
difference in stage at diagnosis or 2-year mortality rate between the groups.
Conclusions
The ED played a pivotal role in the clinical and diagnostic evaluations of patients
with CRC at our institution. Emergency department physicians provided timely diagnoses
of CRC because the stage at diagnosis and 2-year mortality rate of ED patients were
not compromised compared with that of patients referred from non-ED sources. Efforts
should be made to reduce the numbers of patients with late presentations and acute
complications associated with in-hospital mortality.
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References
- Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation.Radiology. 2002; 225: 159-164
- Multi-detector computed tomography of acute abdomen.Eur Radiol. 2005; 15: 2435-2447
- Cancer presentation in the emergency department: a failure of primary care.Am J Emerg Med. 1992; 10: 290-293
- Cancer diagnosis and outcomes in Michigan EDs vs other settings.Am J Emerg Med. 2012; 30: 283-292
- Emergency presentation of colorectal cancer is associated with poor 5-year survival.Br J Surg. 2004; 91: 605-609
- Colon cancer incidence, presentation, treatment and outcomes over 25 years.Colorectal Dis. 2011; 13: 512-518
- The association between referral source and stage of disease in patients with colorectal cancer.Colorectal Dis. 2008; 10: 58-62
- Risk factors in patients presenting as an emergency with colorectal cancer.Br J Surg. 1995; 82: 321-323
- Emergent right hemicolectomies.Am Surg. 2005; 71 ([discussion 56–7]): 653-656
- Implications of new colorectal cancer screening technologies for primary care practice.Med Care. 2008; 46: S138-S146
- Is there a difference in survival between right- versus left-sided colon cancers?.Ann Surg Oncol. 2008; 15: 2388-2394
- Tumor subsite location within the colon is prognostic for survival after colon cancer diagnosis.Dis Colon Rectum. 2009; 52: 1359-1366
- Continued change in the distribution of colorectal carcinoma.Br J Surg. 1998; 85: 246-248
- Incidental finding of colorectal cancer in screening colonoscopy and its cost effectiveness.Am Surg. 2009; 75 ([discussion 03–4]): 699-703
- Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population.Arq Gastroenterol. 2007; 44: 2-7
- The effect of obstruction and perforation on colorectal cancer disease-free survival.World J Surg. 2010; 34: 1091-1101
- Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends.Surgery. 2000; 127: 370-376
- Clinicopathological features of perforated colorectal cancer.Anticancer Res. 2009; 29: 1681-1684
- National trends in use of computed tomography in the emergency department.Ann Emerg Med. 2011; 58: 452-462.e3
- Computed tomography scan utilization in emergency departments: a multi-state analysis.J Emerg Med. 2011; 41: 302-309
- Accuracy of multidetector computed tomography in identifying poor prognostic factors in colonic cancer.Br J Surg. 2010; 97: 1407-1415
- Prognostic value of MDCT in malignant large-bowel obstructions.La Radiologia Medica. 2010; 115: 747-757
- Clinical significance of bowel wall thickening detected with 64-slice multidetector computed tomography.Korean J Gastroenterol. 2009; 54: 149-154
- Diagnostic precision of CT in local staging of colon cancers: a meta-analysis.Clin Radiol. 2010; 65: 708-719
Article Info
Publication History
Published online: February 04, 2013
Accepted:
November 13,
2012
Received in revised form:
November 12,
2012
Received:
October 4,
2012
Footnotes
☆This study was supported, in part, by research grants from Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (grant numbers TSGH-C101-063 and TSGH-C101-064 ).
☆☆Contributorship statement: Y.L. Chen: data collection and manuscript drafting; W.C. Chang: data collection and imaging studies review; H.F. Hsu: data collection and imaging studies review; C.W. Hsu: critical manuscript review; Y.Y. Lin: statistical analysis and manuscript preparation; S.H. Tsai: study design and manuscript preparation.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
