转移性骨肿瘤患者医源性诊断延迟的相关因素研究

Analysis of iatrogenic factors related to delay in diagnosis of metastatic bone tumor

目的:分析影响转移性骨肿瘤患者医源性诊断延迟的相关因素,为转移性骨肿瘤的早期诊断提供参考依据。方法:采用多分类无序反应变量logistic回归分析2006年1月～2011年11月转移性骨肿瘤患者入院时性别、年龄、首诊症状、首诊医院等级、首诊科室、首诊是否病理检查、首诊至病理检查的时间、首诊至确诊经过几个科室及首诊至确诊间有无治疗处理等对转移性骨肿瘤患者医源性诊断延迟的影响。结果:126例患者,医源性诊断延迟率为(72.2%91/126);诊断延迟1～88周,中位数5周。首诊是否进行病理检查、首诊至病理检查时间、首诊至确诊经过几个科室、确诊前有无进行治疗与医源性诊断延迟间存在显著性相关(P<0.01)。结论:首诊即在专业骨科诊断室进行并作病理检查,尽可能减少采取确诊前非针对性治疗,可减少医源性诊断延迟的发生。

Objective To investigate the clinical iatrogenllic factors related to delay in diagnosis of metastatic bone tumor and provide evidences for treatment and prevention in patients metastatic bone tumor.Method From January 2006 to November 2011,a total 126 patients with metastatic bone tumor in Qiannan autonomous prefecture for Buyi and Miao Nationalities Hospital were studied.These factors included sex,age,the first diagnosed symptom,the rank of first diagnosed hospital,first diagnosed department,having pathological examination or not,length of time from the first clinical visit to adopting pathological diagnosis,the number of clinical departments visited,taking any treatment before and so on.For iatrogenic（professional） delay,stepwise multiple logistic regression analysis were applied to analyze the correlation between the professional delay in diagnosis and possible related clinical factors.Results The rate of delay in diagnosis was 72.2%（91/126） whether adopting pathological diagnosis at the first clinical management,length of time from the first clinical visit to adopting pathological diagnosis,number of clinical department visited and whether taking any treatment before definitive diagnosis had significant influence on the delay.Conclusion Taking pathological diagnosis at the first clinical visit,shortening the time from the first visit to pathological diagnosis and less undirected treatment can reduce the iatrogenic delay.