Suspected malignant cord compression - improving time to diagnosis via a 'hotline': a prospective audit.
The aim of the study was to achieve earlier diagnosis of malignant cord compression (MCC) using urgent magnetic resonance imaging (MRI) for selected patients. A comparison was carried out of the current prospective audit of 100 patients referred by a general practitioner or a consultant over 32 months with both a previous national Clinical Research and Audit Group (CRAG) prospective audit (324 cases of MCC) and an earlier retrospective audit of 104 patients referred with suspected MCC. A telephone hotline rapid-referral process for patients with known malignancy and new symptoms (severe nerve root pain +/- severe back pain) was designed. Patients were considered for urgent MRI after discussion with a senior clinician responsible for the hotline. Appropriate referrals were discussed with radiology and oncology ensuring timely MRI reporting and intervention. The main outcome measures are as follows: time from referral to diagnosis; time from the onset of symptoms to diagnosis; and mobility at diagnosis. A total of 50 patients (52%) of those scanned had either MCC (44) or malignant nerve root compression (6) compared with the earlier rate of 23 out of 104 patients (22%). Ten out of 44 MCC patients (23%) were paralysed at diagnosis, compared with 149 out of 324 (46%) in the CRAG audit. Time from reporting pain to diagnosis was 32 days compared with 89 days in the CRAG audit. Median time from referral to diagnosis was 1 day, again considerably shorter than the CRAG audit time of 15 days (interquartile (IQ) range: 3-66). In patients at risk of MCC, fast-track referral with rapid access to MRI reduces time between symptom onset and diagnosis, improves mobility at diagnosis and reduces the number of negative MRI scans.
Allan
L
L
Department of Palliative Medicine, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK.
Baker
L
L
Dewar
J
J
Eljamel
S
S
Grant
R M
RM
Houston
J G
JG
McLeay
T
T
Munro
A J
AJ
Levack
P
P
D000369:Aged, 80 and over; D001416:Back Pain / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors