The objective of this study was to compare the pre-hospital health care process, clinical characteristics at admission and survival of patients with a digestive tract cancer first admitted to hospital either electively or via the emergency department.
The study involved cross-sectional analysis of information elicited through personal interview and prospective follow-up.
The setting was a 450-bed public teaching hospital primarily serving a low-income area of Barcelona, Catalonia, Spain.
Two hundred and forty-eight symptomatic patients were studied, who had cancer of the oesophagus (n=31), stomach (n=70), colon (n=82) and rectum (n=65).
The main outcome measures were stage, type and intention of treatment and time elapsed from admission to surgery ; the relative risk of death was calculated using Cox's regression.
There were 161 (65%) patients admitted via the emergency department and 87 (35%) electively.
The type of physician seen at the first pre-hospital visit had more often been a general practitioner in the emergency than in the elective group (89% vs 75%, P<0.01).
Emergency patients had seen a lower number of physicians from symptom onset until admission, but two-thirds had made repeated visits to a primary care physician.
Emergency patients were less likely to have a localized tumour and a diagnosis of cancer at admission, and surgery as the initial treatment.
Median survival was 30 months for elective patients and 8 months for emergency patients. (...)
Mots-clés Pascal : Tumeur maligne, Tube digestif, Service urgence, Symptomatologie, Diagnostic, Soin santé primaire, Pronostic, Espagne, Europe, Homme
Mots-clés Pascal anglais : Malignant tumor, Digestive tract, Emergency department, Symptomatology, Diagnosis, Primary health care, Prognosis, Spain, Europe, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0110390
Code Inist : 002B13B01. Création : 22/06/1998.