title: Analysis of the referral pattern to a supraregional bone and soft tissue tumour service.
abstract: OBJECTIVE
  To investigate the sources of delay in diagnosis and determine if there was a similar diagnostic error rate as found by the Musculoskeletal Tumour Society, which subsequently altered patients' management and affected outcome.
  
  
  METHODS
  A prospective review of 100 consecutive patients referred to our institution analysed causes for delay in referral and whether prior investigations or procedures had complicated further management.
  
  
  RESULTS
  Patients were symptomatic for 14.8 months (range, 0-26 months) prior to consultation with their GP. A further 13.5 months (range, 0.5-120 months) elapsed before referral by the local hospital (94) or GP (6) to the bone and soft tissue service. A significant delay in referral of more than a month occurred in 72 patients. Those patients with malignant disease were symptomatic for 7.6 months (range, 0.5-11 months) prior to seeking medical advice with a further 7.5 months (range, 0-13 months) elapsing prior to onward referral at their local hospital. From the study group, 63 patients were subjected to complex imaging studies (bone scan, CT, MRI) prior to referral; 34 biopsies or surgery were performed in 34 cases by referring teams, 16 of which complicated subsequent management.
  
  
  CONCLUSIONS
  If a high suspicion of a soft tissue or bone tumour is suspected from the history, examination and plain radiograph, then early referral to a specialist centre is recommended where relevant, high-quality investigations can be arranged in a short time leading to a planned biopsy, confirmation of diagnosis and definitive treatment at an earlier stage.
authors.affiliation: Department of Orthopaedic Surgery, The Middlesex Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Ashwood
authors.forename: J D
authors.initials: JD
authors.lastname: Witt
authors.forename: P J
authors.initials: PJ
authors.lastname: Hallam
authors.forename: J P
authors.initials: JP
authors.lastname: Cobb
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis*; D003951:Diagnostic Errors; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation; D012983:Soft Tissue Neoplasms / Q000175:diagnosis*; D013997:Time Factors; D014850:Waiting Lists