%0 Journal Article
%T Missed opportunities in early diagnosis of symptomatic colorectal cancer Oportunidades perdidas en el diagn車stico temprano del c芍ncer colorrectal sintom芍tico
%A Maite Dom赤nguez-Ayala
%A Jonathan D赤ez-Vallejo
%A 芍ngel Comas-Fuentes
%J Revista Espaˋola de Enfermedades Digestivas
%D 2012
%I The Spanish Society of Digestive Pathology
%X Objective: delays in diagnosis of symptomatic colorectal cancer are a reality in our context. This study aims at identifying missed diagnostic opportunities, describing events, clinical clues and most common mistakes, and quantifying delays. Material and methods: an observational descriptive study was performed in order to review all case histories. Two experts reviewed the case histories of all the patients from the 4th Catchment Area of Asturias diagnosed with colorectal cancer in 2009. All data were analysed using bivariate and multivariate logistic regression. Results: full information on 119 patients out of 143 patients was collected. 34.45% had a clinical missed opportunity -confidence interval (CI) 95%: 30.92-39.68-. Outcomes show an average of 2.41 missed opportunities and 2.61 diagnostic clinical clues per patient. The number of patients with missed opportunities was significantly higher. The total amount of co-morbidities was higher in patients with missed opportunities (2.7). This was the main determinant. The main diagnostic key was iron-deficiency anaemia (46.3%). It produced the longest delay (300 days). Not having requested diagnostic tests was the most common mistake (43.3%). Having at least one missed opportunity entailed an average delay of 235.8 days between the first visit to the office and the referral to a consultant. Conclusions: in clinical practice, missed opportunities to start a diagnostic assessment in patients with presumptive diagnosis of colorectal cancer are common. The most significant clinical clue and the one generating the longest delay is iron-deficiency anaemia. The diagnostic delay is important and is caused mainly by not identifying symptoms. Objetivo: los retrasos en el diagn車stico de c芍ncer colorrectal sintom芍tico son una realidad en nuestro medio. Nos proponemos identificar los casos en los que hubo oportunidad perdida para el diagn車stico, describir las caracter赤sticas de los episodios, las claves cl赤nicas, los errores m芍s comunes y cuantificar el retraso generado. Material y m谷todos: mediante un estudio observacional descriptivo, se procedi車 a la revisi車n de las historias cl赤nicas por dos revisores de la totalidad de los pacientes diagnosticados de c芍ncer colorrectal en el 2009 del 芍rea Sanitaria IV de Asturias. Se analizaron los datos a nivel bivariante y multivariante por regresi車n log赤stica. Resultados: de 143 se obtuvo informaci車n completa de 119 pacientes. Un 34,45% present車 una oportunidad perdida cl赤nica (IC 95%: 30,92-39,68). Hubo una media de 2,41 oportunidades perdidas y 2,61 claves diagn車sticas por p
%K C芍ncer colorrectal
%K Retraso diagn車stico
%K Calidad
%K Colorectal cancer
%K Delayed diagnosis
%K Quality
%U http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082012000700002