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Am J Surg. 2018 Aug;216(2):286-292. doi: 10.1016/j.amjsurg.2017.10.030. Epub 2017 Nov 3.

Gastric cancer diagnosis after presentation to the ED: The independent association of presenting location and outcomes.

Author information

1
Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA.
2
Montefiore Medical Center/Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA.
3
Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA. Electronic address: hin@montefiore.org.

Abstract

BACKGROUND:

The impact of diagnosis location on gastric cancer (GC) outcomes is poorly defined.

METHODS:

Detailed chart review was conducted to identify presenting location leading to diagnosis and treatment for GC patients at a single institution (2009-2013). Patients treated non-emergently following a diagnosis prompted by an ED visit (EDdx) were compared with those diagnosed at other locations (non-EDdx).

RESULTS:

EDdx patients comprised 52% of 263 GC patients. They were older, had later cancer stages (stage IV: 50% vs. 24%), more comorbidities (≥3: 68% vs. 47%), and presented with non-specific symptoms like bleeding (21% vs. 5%). Both groups were of similar race and insurance status. In a model adjusted for stage, EDdx was associated with increased mortality (aHR 1.9; 95% CI: 1.2-2.9).

CONCLUSION:

Half of GC patients had an ED visit prompting diagnosis, which is independently associated with increased mortality. Efforts should focus on reducing EDdx rates to improve GC outcomes.

KEYWORDS:

Cancer diagnosis; Emergency department; Gastric cancer

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