Emergency department utilization can indicate early diagnosis of digestive tract cancers: A population-based study in Taiwan.
OBJECTIVE
Patients who visit emergency department (ED) may have symptoms of occult cancers.


METHODS
We studied a random cohort of one million subjects from Taiwan National Health Insurance Research Database between 2000 and 2008 to evaluate the ED utilization of individuals who were subsequently diagnosed with digestive tract cancers. The case group was digestive tract cancer patients and the control group was traumatic fracture patients. We reviewed record of ED visits only from 4 to 15 months before the cancer diagnoses.


RESULTS
There were 2635 and 6665 in the case and control groups respectively. Patients' adjusted odds ratio with 95% confidence interval for the case group were 1.36 (1.06-1.74) for Abdominal ultrasound, 2.16 (1.61-2.90) pan-endoscopy, 1.72 (1.33-2.22) guaiac fecal-occult blood test, 1.42 (1.28-1.58) plain abdominal X-rays, 1.20 (1.09-1.32) SGOT, 1.27 (1.14-1.40) SGPT, 1.66 (1.41-1.95) total bilirubin, 2.41 (1.89-3.08) direct bilirubin, 1.21 (1.01-1.46) hemoglobin and 3.63 (2.66-4.94) blood transfusion, respectively. Blood transfusion in the ED was a significant predictor of the individual subsequently diagnosed with digestive tract cancer.


CONCLUSIONS
The health system could identify high risk patients early by real-time review of their ED utilization before the diagnosis of digestive tract cancers. We proposed a follow-up methodology for daily screening of patients with high risk of digestive tract cancer by informatics system in the ED.
Emergency Department, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: lsk@wanfang.gov.tw.
Carlos
C
Lam
Department of Healthcare Administration, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Beitun District, Taichung City 40601, Taiwan. Electronic address: jfkuan@ctust.edu.tw.
Ching-Feng
CF
Kuan
College of Medical Science and Technology, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan. Electronic address: jamesmiser@gmail.com.
James
J
Miser
Emergency Department, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: b8601042@tmu.edu.tw.
Kun-Yi
KY
Hsieh
Center of Excellence for Cancer Research, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan. Electronic address: runawayyu@hotmail.com.
Yu-Ann
YA
Fang
Center of Excellence for Cancer Research, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan; Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan. Electronic address: jack@tmu.edu.tw.
Yu-Chuan
YC
Li
Department of Critical and Emergency Medicine, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: 101025@w.tmu.edu.tw.
Chin-Wang
CW
Hsu
Department of Critical and Emergency Medicine, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: rayjchen@tmu.edu.tw.
Ray-Jade
RJ
Chen
Center of Excellence for Cancer Research, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, No. 250, Wu-Xin Street, Taipei City 110, Taiwan; Cancer Center, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing-Long Road, Taipei City 116, Taiwan. Electronic address: dcchen@tmu.edu.tw.
Chang-I
CI
Chen
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D016208:Databases, Factual; D055088:Early Detection of Cancer; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion; D005243:Feces; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008490:Medical Informatics; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D013624:Taiwan; D055815:Young Adult
Cancer; Diagnosis; Emergency department; Predictor