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背景因为病因复杂,癌症被诊断为较常见的急症。一部分诊断为急症的癌症患者存在不明症状就诊的经历。目的本文旨在调查因相关症状去社区医院就诊的被诊断为急症的癌症患者,其中部分患者有多次社区医院就诊经历。设计和场所二次分析2010年英国癌症患者就诊经历调查数据,此数据曾用于人群诊断的调查。方法被诊断为急症的患者共患有18种癌症。采用Logistic回归分析,从患者既往社区医院就诊状况及有3次或以上既往社区医院就诊经历2方面分析其与被诊断为急症的癌症之间的关系。结果 4 647例被诊断为急症的癌症患者中,1 349例(29%)无既往社区医院就诊经历,其中男性多于女性(32%vs.25%,P<0.001),高龄者多于年轻者(44%的年龄≥85岁vs.30%的年龄65~74岁,P<0.001),生活条件差者多于生活条件好者(35%vs.25%,P=0.001);将癌症发病部位作为自变量来分析,患病率最高的癌症为脑瘤(46%),患病率最低的癌症为间皮瘤(13%)(P<0.001)。3 298例有既往社区医院就诊经历的患者中,1 356例(41%)有过3次及以上就诊次数,其中女性多于男性(P<0.001),年轻者多于年长者(P<0.001),非白种人多于白种人(P=0.017);既往社区医院就诊次数最多的为多发性骨髓瘤患者,而最少的为白血病患者(P<0.001)。结论与其他认为癌症患者被诊断为急症意味着漏诊的研究相反,本研究中,约1/3的癌症患者尤其是年长及生活条件差的人群无既往社区医院就诊史,而且有多次(3次及以上)既往社区医院就诊经历的患者中,有1/3所患疾病不难明确诊断。
Background Because of the complex cause, cancer is diagnosed as the more common emergency. A subset of cancer patients diagnosed with acute illness have unexplained symptoms. PURPOSE This paper aims to investigate patients diagnosed with acute cancer who have been referred to a community hospital for relevant symptoms, some of whom have multiple community hospital visits. Design and Site Secondary Analysis 2010 survey of cancer patient visits in the UK, used to investigate population diagnoses. Methods Patients diagnosed as having an emergency had a total of 18 types of cancer. Logistic regression analysis was used to analyze the association with cancers diagnosed as having an emergency, based on the patient’s past visit to the community hospital and the experience of having three or more previous community hospitals. RESULTS: Of the 4 647 cancer patients who were diagnosed with acute illness, 1 349 (29%) had no previous hospital visit, with more males than females (32% vs.25%, P <0.001), older adults than younger ones (44% of patients ≥85 years of age vs. 30% of patients aged 65-74 years, P <0.001), worse living conditions than those with good living conditions (35% vs.25%, P = 0.001) The disease site was analyzed as an independent variable, with the highest prevalence of cancers being brain tumors (46%) and the lowest cancers being mesothelioma (13%) (P <0.001). Of the 3 298 patients who had previous community hospital visits, 1 356 (41%) had 3 or more visits, with more women than men (P <0.001) and younger (P < 0.001). Non-white people were more than Caucasians (P = 0.017). The most frequently visited community hospitals were patients with multiple myeloma and the least patients with leukemia (P <0.001). CONCLUSIONS In contrast to other studies that suggest that cancer patients are diagnosed as having acute illness, which is a missed diagnosis, about one-third of cancer patients in this study, especially older and less well-to-do people, had no prior community hospital visit and had multiple 3 times and above) In the past community hospital experience of patients, 1/3 of the disease is not difficult to confirm the diagnosis.