Emergency Department Visits Before Cancer Diagnosis Among Women at Mayo Clinic

Objective

To determine associations of incident cancer diagnoses in women with recent emergency department (ED) care.

Patients and Methods

A retrospective cohort study analyzing biological females aged 18 years and older, who were diagnosed with an incident primary cancer (12 cancer types studied) from January 1, 2015, to December 31, 2021, from electronic health records. The primary outcome was a cancer diagnosis within 6 months of a preceding ED visit. Secondary outcomes included patient factors associated with a preceding ED visit.

Results

Of 25,736 patients (median age of 62 years, range 18-101) diagnosed with an incident primary cancer, 1938 (7.5%) had an ED visit ≤6 months before a diagnosis. The ED-associated cancer cases were highest in lung cancer (n=514, 14.7%) followed by acute lymphoblastic leukemia (n=22, 13.3%). Patient factors increasing the likelihood of ED evaluation before diagnosis included 18-50 years of age (OR=1.32; 95% CI, 1.09-1.61), Elixhauser score (measure of comorbidities) >4 (OR=17.90; 95% CI, 14.21-22.76), use of Medicaid or other government insurance (OR=2.10; 95% CI, 1.63-2.69), residence within the institutional catchment areas (OR=3.18; 95% CI, 2.78-3.66), non-Hispanic Black race/ethnicity (OR=1.41; 95% CI, 1.04-1.88), and established primary care provider at Mayo Clinic (OR=1.45; 95% CI, 1.28-1.65). The ED visits were more likely in those who died within 6 months of diagnosis (n=327, 37.8%) than those who did not die (n=1611, 6.5%).

Conclusion

Patient characteristics identified in this study offer opportunities to provide cancer risk assessment and health navigation, particularly among individuals with comorbidities and limited health care access.

Dual Energy CT Has Additional Prognostic Value over Clinical Measures in Gout Including Tophi: A Systematic Literature Review

OBJECTIVE

This Systematic Literature Review determined whether there is clinical utility for Dual Energy CT (DECT) to inform on prognosis for gout patients. With DECT, individualized treatment plans could be developed based on the patient's unique urate burden, with DECT used as a clinical outcome measure in gout management.

METHODS

To evaluate DECT as a reliable, valid, and sensitive prognostic instrument, a librarian-assisted search was undertaken in PubMed and EMBASE for articles on gout and DECT informing on reliability, validity (content, construct, criterion), sensitivity to change and minimum clinically important changes.

RESULTS

This systematic literature review showed that DECT has high intra- and inter-rater reliability. Tophus burden correlates with functional loss to show content validity. DECT volume is positively correlated with death and cardiovascular risk factors, and the risk for future gout flares. DECT has excellent sensitivity to change with effective urate lowering therapies.

CONCLUSION

DECT is a promising prognostic tool based on its high reliability, sensitivity to change, and emerging validity. Additional large, well-designed prospective cohort studies are needed to fully evaluate its prognostic utility. This systematic review suggests it's very likely DECT has additional prognostic information beyond clinical tophi assessment alone.