Demografi og triage af børn med akutte mavesmerter

Formålet med dette studie var primært at beskrive populationen af børn med mavesmerter i de danske akutmodtagelser. Det sekundære formål var at undersøge, om det danske triagesystem viser en tendens til at kunne detektere, hvem der har potentielt livstruende sygdomme (PLS – appendicitis anvendt som indikator), eller omvendt udelukke, hvem der ikke har. Data for alle børn med ”mave- og flankesmerter” i skadestuen på Aarhus Universitetshospital (AUH) i 2017 er inkluderet i dette retroperspektive kohorte-studie. Børnene kategoriseres efter en række karakteristika (alder, køn mv.), og der er vist grafer over triagefordelingen for hver gruppe. 276 børn er inkluderet. Medianalderen var 12 år, med 46% drenge og 54% piger. De fleste havde stærke smerter (239 patienter; 87%) og 90 børn (33%) havde påvirkede vital-parametre. 148 børn (66%) fik en uspecifik diagnose, mens 94 børn (34%) fik en specifik. Appendicitis blev fundet i alle triagekategorier. Data viser en tendens til, at en lav triagescore ikke udelukker PLS (som appendicitis). Det kan sammenfattes, at børn med mavesmerter præsenterer sig meget forskelligt, og at vitalparametrene ved ankomst ikke altid afspejler alvorligheden af den tilstand, som barnet indlægges med. ENGLISH The main aim of this study was to describe characteristics of children presenting with abdominal pain in a Danish Emergency Department (ED). The secondary aim was to assess if the present triage system in the Danish EDs is indicative of children with potentially life-threatening diseases (PLTD – appendicitis used as indicator). Data of all children with “abdominal and flank pain” in the ED at Aarhus University Hospital (AUH) during 2017 were included in this retrospective cohort study. Patients were classified according to several characteristics (e.g. age, gender) and graphs of triage distribution were shown and compared. A total of 276 children were included. Median age was 12 years, with 46% boys and 54% girls. Most patients had severe pain (239 patients, 87%) and 90 patients (33%) had affected vital parameters. A total of 148 patients (66%) got an unspecific diagnosis at discharge, while 94 patients (34%) got a specific diagnosis. Appendicitis was found in all triage categories. Data show a tendency towards low triage not excluding PLTD (such as appendicitis). Also, data suggest that children with abdominal pain show a great variation in symptoms, and vital parameters at admission does not always reflect the severity of the child’s condition

Use of primary care during the year before childhood cancer diagnosis: a nationwide population-based matched comparative study.

ObjectiveChildhood cancer is rare and symptoms tend to be unspecific and vague. Using the utilization of health care services as a proxy for symptoms, the present study seeks to determine when early symptoms of childhood cancer are seen in general practice.MethodsA population-based matched comparative study was conducted using nationwide registry data. As cases, all children in Denmark below 16 years of age (N = 1,278) diagnosed with cancer (Jan 2002-Dec 2008) were included. As controls, 10 children per case matched on gender and date of birth (N = 12,780) were randomly selected. The utilization of primary health care services (daytime contacts, out-of-hours contacts and diagnostic procedures) during the year preceding diagnosis/index date was measured for cases and controls.ResultsDuring the six months before diagnosis, children with cancer used primary care more than the control cohort. This excess use grew consistently and steadily towards the time of diagnosis with an IRR = 3.19 (95%CI: 2.99-3.39) (pConclusionsThe study shows that excess health care use, a proxy for symptoms of childhood cancer, occurs months before the diagnosis is established. Children with lymphoma, bone tumour or other solid tumours had higher consultation rates than the controls in the last five months before diagnosis, whereas children with CNS tumour had higher consultation rates in all twelve months before diagnosis. More knowledge about early symptoms and the diagnostic pathway for childhood cancer would be clinically relevant

The sampling of patients with incident and primary cancer.

<p>The sampling of patients with incident and primary cancer.</p

Percentages of children with four or more consultations in general practice during the three months before diagnosis and likelihood ratio of four or more consultations.

*<p>CI = confidence interval.</p

Incidence rate ratios (IRR) for consultations in primary care with 95% confidence intervals for carcinoma, lymphoma, germ cell tumour, central nervous system tumour, malignant melanoma, leukaemia bone tumour, soft tissue tumour and unspecified neoplasm two years before diagnosis (index date).

<p>Incidence rate ratios (IRR) for consultations in primary care with 95% confidence intervals for carcinoma, lymphoma, germ cell tumour, central nervous system tumour, malignant melanoma, leukaemia bone tumour, soft tissue tumour and unspecified neoplasm two years before diagnosis (index date).</p

Incidence rate ratios (IRR) for blood tests in primary care with 95% confidence intervals for haematological cancer (lymphoma and leukaemia), malignant melanoma and central nervous system tumour two years before diagnosis (index date).

<p>Incidence rate ratios (IRR) for blood tests in primary care with 95% confidence intervals for haematological cancer (lymphoma and leukaemia), malignant melanoma and central nervous system tumour two years before diagnosis (index date).</p

Upper part: Mean rates for consultations and blood tests in primary care for cases and references two years before the diagnosis (index date).

<p>Note the difference in the Y-axis range. Lower part: incidence rate ratios (IRR) for consultations with 95% confidence intervals.</p

Primary Care Use before Cancer Diagnosis in Adolescents and Young Adults – A Nationwide Register Study

<div><p>Introduction</p><p>Survival rates of cancer patients have generally improved in recent years. However, children and older adults seem to have experienced more significant clinical benefits than adolescents and young adults (AYAs). Previous studies suggest a prolonged diagnostic pathway in AYAs, but little is known about their pre-diagnostic healthcare use. This study investigates the use of primary care among AYAs during the two years preceding a cancer diagnosis.</p><p>Methods</p><p>The study is a retrospective population-based matched cohort study using Danish nationwide registry data. All persons diagnosed with cancer during 2002–2011 in the age group 15–39 years were included (N = 12,306); each participant was matched on gender, age and general practice with 10 randomly selected references (N = 123,060). The use of primary healthcare services (face-to-face contacts, blood tests and psychometric tests) was measured during the two years preceding the diagnosis (index date), and collected data were analysed in a negative binomial regression model.</p><p>Results</p><p>The cases generally increased their use of primary care already from 8 months before a cancer diagnosis, whereas a similar trend was not found for controls. The increase was observed for all cancer types, but it started at different times: 17 months before a diagnosis of CNS tumour, 12 months before a diagnosis of soft tissue sarcoma, 9 months before a diagnosis of lymphoma, 5–6 months before a diagnosis of leukaemia, bone tumour or GCT, and 3 months before a diagnosis of malignant melanoma.</p><p>Conclusion</p><p>The use of primary care among AYAs increase several months before a cancer diagnosis. The diagnostic intervals are generally short for malignant melanomas and long for brain tumours. A prolonged diagnostic pathway may indicate non-specific or vague symptomatology and low awareness of cancer among AYAs primary-care personnel. The findings suggest potential of faster cancer diagnosis in AYAs.</p></div

Rates for consultations and diagnostic tests in daytime for children with cancer and control persons.

<p>Rates (mean number of consultations/diagnostic tests per 3 months interval) and incidence rate ratios (IRR) for children with cancer and control persons the year before diagnosis (for cases)/index day (for controls). The IRRs are presented with 95% confidence intervals (95%CIs).</p>*<p>p<0.05.</p>†<p>p<0.001.</p>††<p>p<0.0001.</p

Childhood cancer patients and controls in general practice during the 12 months before diagnosis.

<p>The curves show the proportion with the latest, the second latest and third latest consultation (y-axis) the year before cancer diagnosis (x-axis). For comparison, the same is shown for the matched control children until the index day. E.g. 64% of the children with cancer are seen once within a month before the diagnosis, whereas this figure is 21% for the control children.</p