Missed opportunities in early diagnosis of symptomatic colorectal cancer Oportunidades perdidas en el diagnóstico temprano del cáncer colorrectal sintomático

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 diagnóstico de cáncer colorrectal sintomático son una realidad en nuestro medio. Nos proponemos identificar los casos en los que hubo oportunidad perdida para el diagnóstico, describir las características de los episodios, las claves clínicas, los errores más comunes y cuantificar el retraso generado. Material y métodos: mediante un estudio observacional descriptivo, se procedió a la revisión de las historias clínicas por dos revisores de la totalidad de los pacientes diagnosticados de cáncer colorrectal en el 2009 del área Sanitaria IV de Asturias. Se analizaron los datos a nivel bivariante y multivariante por regresión logística. Resultados: de 143 se obtuvo información completa de 119 pacientes. Un 34,45% presentó una oportunidad perdida clínica (IC 95%: 30,92-39,68). Hubo una media de 2,41 oportunidades perdidas y 2,61 claves diagnósticas por p