Carlos Lam1, Ching-Feng Kuan2, James Miser3, Kun-Yi Hsieh4, Yu-Ann Fang5, Yu-Chuan Li6, Chin-Wang Hsu7, Ray-Jade Chen8, Chang-I Chen9. 1. Emergency Department, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: lsk@wanfang.gov.tw. 2. Department of Healthcare Administration, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Beitun District, Taichung City 40601, Taiwan. Electronic address: jfkuan@ctust.edu.tw. 3. College of Medical Science and Technology, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan. Electronic address: jamesmiser@gmail.com. 4. Emergency Department, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: b8601042@tmu.edu.tw. 5. Center of Excellence for Cancer Research, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan. Electronic address: runawayyu@hotmail.com. 6. Center of Excellence for Cancer Research, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan; Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan. Electronic address: jack@tmu.edu.tw. 7. Department of Critical and Emergency Medicine, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: 101025@w.tmu.edu.tw. 8. Department of Critical and Emergency Medicine, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: rayjchen@tmu.edu.tw. 9. Center of Excellence for Cancer Research, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan; Cancer Center, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: dcchen@tmu.edu.tw.
Abstract
BACKGROUND AND OBJECTIVE: Patients who visit emergency department (ED) may have symptoms of occult cancers. METHODS: We studied a random cohort of one million subjects from Taiwan National Health Insurance Research Database between 2000 and 2008 to evaluate the ED utilization of individuals who were subsequently diagnosed with digestive tract cancers. The case group was digestive tract cancer patients and the control group was traumatic fracture patients. We reviewed record of ED visits only from 4 to 15 months before the cancer diagnoses. RESULTS: There were 2635 and 6665 in the case and control groups respectively. Patients' adjusted odds ratio with 95% confidence interval for the case group were 1.36 (1.06-1.74) for Abdominal ultrasound, 2.16 (1.61-2.90) pan-endoscopy, 1.72 (1.33-2.22) guaiac fecal-occult blood test, 1.42 (1.28-1.58) plain abdominal X-rays, 1.20 (1.09-1.32) SGOT, 1.27 (1.14-1.40) SGPT, 1.66 (1.41-1.95) total bilirubin, 2.41 (1.89-3.08) direct bilirubin, 1.21 (1.01-1.46) hemoglobin and 3.63 (2.66-4.94) blood transfusion, respectively. Blood transfusion in the ED was a significant predictor of the individual subsequently diagnosed with digestive tract cancer. CONCLUSIONS: The health system could identify high risk patients early by real-time review of their ED utilization before the diagnosis of digestive tract cancers. We proposed a follow-up methodology for daily screening of patients with high risk of digestive tract cancer by informatics system in the ED.
BACKGROUND AND OBJECTIVE:Patients who visit emergency department (ED) may have symptoms of occult cancers. METHODS: We studied a random cohort of one million subjects from Taiwan National Health Insurance Research Database between 2000 and 2008 to evaluate the ED utilization of individuals who were subsequently diagnosed with digestive tract cancers. The case group was digestive tract cancerpatients and the control group was traumatic fracturepatients. We reviewed record of ED visits only from 4 to 15 months before the cancer diagnoses. RESULTS: There were 2635 and 6665 in the case and control groups respectively. Patients' adjusted odds ratio with 95% confidence interval for the case group were 1.36 (1.06-1.74) for Abdominal ultrasound, 2.16 (1.61-2.90) pan-endoscopy, 1.72 (1.33-2.22) guaiac fecal-occult blood test, 1.42 (1.28-1.58) plain abdominal X-rays, 1.20 (1.09-1.32) SGOT, 1.27 (1.14-1.40) SGPT, 1.66 (1.41-1.95) total bilirubin, 2.41 (1.89-3.08) direct bilirubin, 1.21 (1.01-1.46) hemoglobin and 3.63 (2.66-4.94) blood transfusion, respectively. Blood transfusion in the ED was a significant predictor of the individual subsequently diagnosed with digestive tract cancer. CONCLUSIONS: The health system could identify high risk patients early by real-time review of their ED utilization before the diagnosis of digestive tract cancers. We proposed a follow-up methodology for daily screening of patients with high risk of digestive tract cancer by informatics system in the ED.