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Retrospective study of unplanned hospital admission for metastatic cancer patients visiting the emergency department

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Abstract

Purpose

The purpose of the study was to identify factors that predict unplanned admission for metastatic cancer patients visiting the emergency department (ED).

Methods

Patients visiting the ED of a general hospital from April 2012 to March 2013 were investigated retrospectively. Data including demographics, vital signs, and laboratory measurements were collected from a chart review for each patient. Factors related to emergency admission were identified by univariate and multivariate analyses.

Results

A total of 15,716 individuals visiting the ED during the study period included 1244 (7.9%) patients with cancer. Among the 491 cancer patients with metastasis, univariate analysis revealed that emergency admission was significantly associated with an age of ≥76 years; an altered mental status; fever (≥38 °C); a blood oxygen saturation of <90%; a white blood cell (WBC) count of ≤2000 or ≥10,000/μL; hypoalbuminemia (≤2.5 g/dL); and elevated levels of aspartate aminotransferase (≥100 IU/L), blood urea nitrogen (≥25 mg/dL), and C-reactive protein (CRP, ≥10 mg/dL). Multivariate analysis identified age, an altered mental status, hypoxemia, an abnormal WBC count, and elevated CRP as putative independent predictive factors for emergency admission. The number of these five factors present was also correlated with 30-day mortality (c-statistic = 0.72).

Conclusions

Age, unconsciousness, hypoxemia, an abnormal WBC count, and elevated CRP were found to be associated with emergency admission and 30-day mortality for metastatic cancer patients. Prospective validation of a predictive scoring system based on these findings is warranted.

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Authors and Affiliations

  1. Department of Medical Oncology, Kishiwada Municipal Hospital, Kishiwada, Osaka, Japan

    Tae Tanaka, Soichi Fumita, Kunio Okamoto & Hidetoshi Hayashi

  2. Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan

    Tae Tanaka

  3. Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan

    Masataka Taguri

  4. Department of Emergency Medicine, Kishiwada Municipal Hospital, Kishiwada, Osaka, Japan

    Yoshio Matsuo

  5. Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Hidetoshi Hayashi

Authors
  1. Tae Tanaka
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  2. Masataka Taguri
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  3. Soichi Fumita
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  4. Kunio Okamoto
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  5. Yoshio Matsuo
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  6. Hidetoshi Hayashi
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Correspondence to Hidetoshi Hayashi.

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Tanaka, T., Taguri, M., Fumita, S. et al. Retrospective study of unplanned hospital admission for metastatic cancer patients visiting the emergency department. Support Care Cancer 25, 1409–1415 (2017). https://doi.org/10.1007/s00520-016-3535-1

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  • DOI: https://doi.org/10.1007/s00520-016-3535-1

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