Adrenal incidentalomas and effectiveness of patient pathway transformation.

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Danish medical journal Pub Date : 2023-05-10
Christian Trolle, Karen Fjeldborg, Atul Shukla, Andreas Ebbehøj, Per Løgstrup Poulsen, Klavs Würgler Hansen
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引用次数: 0

Abstract

Introduction: A total of 10% of older individuals harbour adrenal incidentalomas and need dedicated adrenal CT to exclude malignancy and biochemical evaluation. These investigations tax medical resources, and diagnostic delay may cause anxiety for the patient. We implemented a no-need-to-see pathway (NNTS) in which low-risk patients only attend the clinic if adrenal CT or hormonal evaluation is abnormal.

Methods: We investigated the impact of a NNTS pathway on the share of patients not requiring an attendance consultation, time to malignancy and hormonal clarification, and time to end of investigation. We prospectively registered adrenal incidentaloma cases (n = 347) and compared them with historical controls (n = 103).

Results: All controls attended the clinic. A total of 63% of cases entered and 84% completed the NNTS pathway without seeing an endocrinologist; 53% of consultations were avoided. Time-to-event analysis revealed a shorter time to clarification of malignancy (28 days; 95% confidence interval (CI): 24-30 days versus 64 days; 95% CI: 47-117 days) and hormonal status (43 days; 95% CI: 38-48 days versus 56 days; 95% CI: 47-68 days) and a shorter time to end of pathway (47 days; 95% CI: 42-55 days versus 112 days; 95% CI: 84-131 days) in cases than controls (p ≤ 0.01).

Conclusion: We demonstrated that NNTS pathways may be an efficient way of handling the increased burden of incidental radiological findings, avoiding 53% of attendance consultations and achieving a shorter time to end of pathway.

Funding: Supported by a grant from Regional Hospital Central Denmark, Denmark. The study was approved by the institutional review boards of all participating hospitals.

Trial registration: Not relevant.

肾上腺偶发瘤与患者途径转化的有效性。
引言:共有10%的老年人患有肾上腺偶发瘤,需要专门的肾上腺CT来排除恶性肿瘤和生化评估。这些调查耗费了医疗资源,诊断延误可能会导致患者焦虑。我们实施了一个不需要看的途径(NNTS),其中低风险患者只有在肾上腺CT或激素评估异常时才去诊所。方法:我们调查了NNTS通路对不需要就诊的患者比例、恶性肿瘤和激素澄清时间以及调查结束时间的影响。我们前瞻性地登记了肾上腺偶发瘤病例(n = 347),并将其与历史对照(n = 103)进行比较。结果:所有对照者均到门诊就诊。共有63%的病例进入NNTS途径,84%的病例在没有看到内分泌学家的情况下完成了NNTS途径;53%的咨询被避免。时间到事件分析显示澄清恶性肿瘤的时间较短(28天;95%置信区间(CI): 24-30天vs 64天;95% CI: 47-117天)和激素状态(43天;95% CI: 38-48天对56天;95% CI: 47-68天)和较短的通路结束时间(47天;95% CI: 42-55天对112天;95% CI: 84 ~ 131天),与对照组比较差异有统计学意义(p≤0.01)。结论:我们证明了NNTS路径可能是一种有效的方法来处理附带放射学发现增加的负担,避免了53%的就诊咨询,并实现了更短的路径结束时间。经费:由丹麦中央丹麦区域医院的赠款支持。这项研究得到了所有参与医院的机构审查委员会的批准。试验注册:不相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Danish medical journal
Danish medical journal MEDICINE, GENERAL & INTERNAL-
CiteScore
2.30
自引率
6.20%
发文量
78
审稿时长
3-8 weeks
期刊介绍: The Danish Medical Journal (DMJ) is a general medical journal. The journal publish original research in English – conducted in or in relation to the Danish health-care system. When writing for the Danish Medical Journal please remember target audience which is the general reader. This means that the research area should be relevant to many readers and the paper should be presented in a way that most readers will understand the content. DMJ will publish the following articles: • Original articles • Protocol articles from large randomized clinical trials • Systematic reviews and meta-analyses • PhD theses from Danish faculties of health sciences • DMSc theses from Danish faculties of health sciences.
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