Background
Methods
Characteristics and functioning of the unit
Study design and population
Criteria | Explanation |
---|---|
Febrile syndrome | Fever of unknown origin and temperature ≥ 38 °C for ≥ 14 days |
Unintentional weight loss | Unaccounted for loss of ≥10% of body weight, anorexia, asthenia for ≥ 42 days |
Anemia | Hemoglobin level < 9 g/L, with or without symptoms |
Chronic diarrhea | Loose stools for ≥ 28 days |
Adenopathies and/or palpable masses | - |
Unexplained severe abdominal pain | - |
Rectorrhagia | - |
Jaundice | - |
Severe constipation (recent onset) | - |
Lung and/or pleural abnormalities | Mainly suggestive of neoplasm. After exclusion of obvious causes including community-acquired pneumonia or residual lesions |
Unexplained dyspnea | - |
Ascites and/or anasarca | - |
Dysphagia | - |
Arthritis | Degenerative osteoarthritis excluded |
Bone pain with suspicion of bone malignancy | - |
Splenomegaly and/or hepatomegaly | No known liver or hematological disease (e.g., chronic myelogenous leukemia) |
Hemogram abnormalities suggestive of primary hematological disorder | - |
Neurologic disorders (central, spinal and peripheral nervous system) | Cerebrovascular disease, delirium, dementia, movement and sleep disorders, dizziness, vertigo, and neuropathic pain excluded. |
Includes Horner’s syndrome | |
Monoclonal paraprotein band with or without suspicion of multiple myeloma | - |
Statistical analysis
Results
Patients evaluated
Patients’ characteristics
Variable | PHC-QDU patients n = 1186 | PHC-ED-QDU patients n = 1004 |
Pvalue |
---|---|---|---|
Age (years) | 58.8 (16.1), 62 [55;67.7] | 56.8 (15.5), 60.3 [53.8;66] |
NS
|
Female | 608 (51.3) | 527 (52.5) | |
Male | 578 (48.7) | 477 (47.5) | |
Main reason for consultation | Unintentional weight loss | Anemia | |
Waiting time for 1st QDU visit (days)* | 2-8 (4.8) | 2-4 (2.6) |
.001
|
Charlson com in. (score) | 1.3 (0.9), 1.1 [0.9;1.5] | 1.2 (0.8), 0.9 [0.7;1.3] |
NS
|
Main diagnosis | Malignant neoplasm | Benign GI disorder-related iron-deficiency anemia | |
Visits per patient (n) | 3.2 (1.8), 3 [2.8;3.3] | 2.9 (1.6), 2.7 [2.6;3] |
NS
|
Time to diagnosis (days) | 9.2 (4), 8.6 [7.9;10.7] | 8.9 (4), 8.4 [7.8;10.4] |
NS
|
Destination
| |||
PHC | 690 (58.2) | 625 (62.2) |
NS
|
Outpatients | 465 (39.2) | 365 (36.4) |
NS
|
Palliative care | 20 (1.7) | 7 (0.7) |
NS
|
Other | 11 (0.9) | 7 (0.7) |
NS
|
Appropriateness of referrals
Reason for consultation | PHC-QDU patients* n = 1186 | PHC-ED-QDU patients† n = 1004 |
---|---|---|
Anemia | 21 (1.8) | 247 (24.6) |
Unintentional weight loss | 4 (0.3) | 119 (11.9) |
Febrile syndrome | 5 (0.4) | 223 (22.2) |
Adenopathies and/or palpable masses | 0 (0) | 37 (3.7) |
Lung and/or pleural abnormalities | 1 (0.08) | 28 (2.8) |
Chronic diarrhea | 2 (0.2) | 20 (2) |
Abdominal pain | 3 (0.3) | 29 (2.9) |
Ascites | 3 (0.3) | 20 (2) |
Rectorrhagia | 1 (0.08) | 160 (15.9) |
Jaundice | 3 (0.3) | 10 (1) |
Dysphagia | 0 (0) | 14 (1.4) |
Arthritis | 0 (0) | 9 (0.9) |
Other | 5 (0.4) | 19 (1.9) |
Total | 48 (4) | 935 (93.1) |
Potential evaluation in a less rapid, non-QDU setting
Interobserver agreement
Variable | Agreement (%) | Unadjusted ϰ | CI 95% |
---|---|---|---|
PHC-QDU referral | 89.6 | 0.81 | 0.77-0.85 |
n = 1186* | |||
PHC-ED referral | 85.6 | 0.75 | 0.71-0.79 |
n = 1004†
|
Reasons for consultation
Reason for consultation | PHC-QDU patients n = 1186 | PHC-ED-QDU patients n = 1004 |
Pvalue |
---|---|---|---|
Anemia | 195 (16.4) | 283 (28.2) |
.005
|
Unintentional weight loss | 293 (24.7) | 123 (12.2) |
.004
|
Febrile syndrome | 135 (11.4) | 237 (23.6) |
.003
|
Adenopathies | 107 (9) | 25 (2.5) |
NS
|
Palpable masses | 42 (3.5) | 12 (1.2) |
NS
|
Lung and/or pleural abnormalities | 66 (5.6) | 31 (3.1) |
NS
|
Chronic diarrhea | 52 (4.4) | 22 (2.2) |
NS
|
Abdominal pain | 76 (6.4) | 30 (3) |
NS
|
Ascites | 26 (2.2) | 21 (2.1) |
NS
|
Rectorrhagia | 44 (3.7) | 163 (16.2) |
.006
|
Jaundice | 21 (1.8) | 12 (1.2) |
NS
|
Dysphagia | 24 (2) | 14 (1.4) |
NS
|
Arthritis | 36 (3) | 9 (0.9) |
NS
|
Total | 1117 (94.2) | 982 (97.8) |
Diagnoses
Diagnosis | PHC-QDU patients n = 1186 | PHC-ED-QDU patients n = 1004 |
Pvalue |
---|---|---|---|
Malignant neoplasm
| 356 (30) | 174 (17.3) |
.003
|
Colorectal | 91 (7.7) | 7 (0.7) |
NS
|
Lymphoma | 83 (7) | 32 (3.2) |
NS
|
Gastric | 23 (1.9) | 26 (2.6) |
NS
|
Lung | 48 (4) | 25 (2.5) |
NS
|
Pancreatic | 53 (4.5) | 51 (5.1) |
NS
|
Other hematological* | 15 (1.3) | 11 (1.1) |
NS
|
Breast | 14 (1.2) | 10 (1) |
NS
|
Other neoplasms | 29 (2.4) | 12 (1.2) |
NS
|
Iron-deficiency anemia
| 158 (13.3) | 254 (25.3) |
.002
|
Digestive | 120 (75.9) | 194 (76.2) |
NS
|
Unknown cause | 18 (11.4) | 31 (12.2) |
NS
|
Heavy menstrual bleeding | 12 (7.6) | 19 (7.5) |
NS
|
Other causes | 8 (5.1) | 10 (4.1) |
NS
|
Multifactorial anemia
| 17 (1.4) | 6 (0.6) |
NS
|
Megaloblastic anemia
| 14 (1.2) | 6 (0.6) |
NS
|
Other types of anemia
| 6 (0.5) | 2 (0.2) |
NS
|
Chronic liver disease
| 40 (3.4) | 7 (0.7) |
NS
|
Irritable bowel syndrome
| 56 (4.7) | 15 (1.5) |
NS
|
Inflammatory bowel disease
| 15 (1.3) | 6 (0.6) |
NS
|
Benign gastroduodenal disorder
| 27 (2.3) | 98 (9.8) |
NS
|
Benign colonic disorder
| 12 (1) | 125 (12.5) |
.004
|
Esophagitis
| 18 (1.5) | 21 (2.1) |
NS
|
Gallbladder disease
| 19 (1.6) | 6 (0.6) |
NS
|
Acute viral illness
| 15 (1.3) | 136 (13.5) |
.005
|
Depressive disorder
| 84 (7.1) | 10 (1) |
NS
|
Reactive adenitis
| 86 (7.3) | 4 (0.4) |
NS
|
Autoimmune rheumatic disease
| 40 (3.4) | 7 (0.7) |
NS
|
Non-malignant lung and/or pleural disease
| 46 (3.9) | 8 (0.8) |
NS
|
Subtotal | 1009 (85.1) | 885 (88.1) | |
Other diagnoses and undiagnosed cases
| 177 (14.9) | 119 (11.9) | |
Total | 1186 (100) | 1004 (100) |