title: Accuracy of recorded tumor, node, and metastasis stage in a comprehensive cancer center.
abstract: OBJECTIVE
  The benefits of recording the tumor, node, and metastasis (TNM) stages of cancer patients are well accepted, but little is known about how accurately this is performed. An audit was performed to determine the accuracy of recorded stage and to act as a baseline before the implementation of an education program.
  
  
  METHODS
  All new patient referrals to Princess Margaret Hospital between July 1 and August 31, 1997, were reviewed. An audit panel composed of five health record technicians (HRTs) and 10 doctors was assembled. Each auditor reviewed 10% of the health record. If there was a discrepancy between the stage in the health record and the auditor stage, then the final stage was determined by the audit committee. Analysis of the agreement between the health record, the physician auditor, the HRT auditor, and the final stage was performed.
  
  
  RESULTS
  A total of 855 patients were referred with a new diagnosis of a malignancy for which there was a TNM stage system; 833 patients (97.4%) had a stage assigned. There was agreement between the health record stage and final stage in 80% (95% confidence interval [CI], 77% to 82%) of cases for clinical stage, compared with 90% (95% CI, 87% to 92%) for pathologic stage. Of the major site groups, lung was the least accurately recorded. The most common major discrepancies were due to the recording of X when a definite category could be assigned.
  
  
  CONCLUSIONS
  This audit demonstrates the importance of staging and provides impetus to develop staging guidelines and education programs.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada. james.brierley@rmp.uhn.on.ca
authors.forename: James D
authors.initials: JD
authors.lastname: Brierley
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Catton
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Janet E
authors.initials: JE
authors.lastname: Dancey
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dowling
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.forename: Thomas S
authors.initials: TS
authors.lastname: McGowan
authors.forename: Jeremy F G
authors.initials: JF
authors.lastname: Sturgeon
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Swallow
authors.forename: George B
authors.initials: GB
authors.lastname: Rodrigues
authors.forename: Tony
authors.initials: T
authors.lastname: Panzarella
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards*; D005568:Forms and Records Control; D006801:Humans; D008175:Lung Neoplasms; D008485:Medical Audit; D008499:Medical Records / Q000592:standards*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012017:Referral and Consultation; D015203:Reproducibility of Results