Patterns of Treatment Delay in Patients with Symptomatic Metastatic Epidural Spinal Cord Compression

被引:0
作者
Wang, Shilin [1 ]
Hallinan, James T. P. D. [2 ]
Tan, Cherie Lin Hui [3 ]
Chua, Khye Gin Eugene [3 ]
Teo, Alex Quok An [1 ]
Kumar, Naresh [1 ]
Liu, Gabriel [1 ]
Hey, Hwee Weng Dennis [1 ]
Thambiah, Joseph [1 ]
Lau, Leok-Lim [1 ]
Wong, Hee-Kit [1 ]
Chan, Yiong-Huak [4 ]
Tan, Jiong Hao Jonathan [1 ]
机构
[1] Natl Univ Hlth Syst, Natl Univ Hosp, Dept Orthopaed Surg, Singapore 119074, Singapore
[2] Natl Univ Hlth Syst, Natl Univ Hosp, Dept Diagnost Imaging, Singapore 119074, Singapore
[3] Nanyang Technol Univ, Lee Kong Chian Sch Med, Singapore 636921, Singapore
[4] Natl Univ Singapore, Yong Loo Lin Sch Med, Biostat Unit, Singapore 117597, Singapore
基金
英国医学研究理事会;
关键词
spine; metastases; cord; compression; MESCC; treatment; delay; outcomes; function; independence; COMPUTER-ASSISTED DETECTION; CEREBRAL ANEURYSMS; CANCER; BONE; CARE; DIAGNOSIS;
D O I
10.3390/cancers17040595
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Delays in the diagnosis and treatment of metastatic epidural spinal cord compression (MESCC) can potentially result in serious, deleterious effects on patient outcomes and postoperative morbidity. Delays may occur any at any step in the chain of care, increasing the risk of preventable complications. Objectives: This study, thus, aims to identify patterns of treatment delays and determine the predictive factors of postoperative ambulatory function in patients with symptomatic MESCC. Methods: Adult patients, aged >18 years, who underwent surgical treatment for MESCC between 2015 and 2022, were included for analysis in this retrospective study. Results: A total of 177 patients were included. The most significant delay contributing to total delay was patient delay (mean duration 41 days) followed by diagnostic delay (mean duration 16 days). Patients presenting acutely to the Emergency Department and patients with neurological deficits were found to have significantly shorter delays. Preoperative neurological deficits (p = 0.001) and preoperative red flag symptoms of cord compression (p = 0.008) were significant factors that were predictive of postoperative functional independence. Referral delay was also a significant predictive factor (p = 0.013); surgical delay approached statistical significance (p = 0.075). Conclusions: The results of this study highlight the need for increasing patient education, enhancing physician management of patients with MESCC, and improving diagnostic efficiency to reduce delays and maximize patient outcomes.
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页数:15
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