Document Detail


Misinterpretation of the chest x ray as a factor in the delayed diagnosis of lung cancer.
MedLine Citation:
PMID:  11884698     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
All patients in 1997 with a histologically proved diagnosis of lung cancer in Castle Hill Hospital in whom a full set of case notes and x rays could be retrieved were studied. All previous chest x rays were reviewed by a consultant chest physician and a radiologist, who were blinded to the eventual site of the lesion and the point at which a suspicious abnormality first appeared. Case notes were inspected to clarify the cause of any error. Fifty eight patients were eligible, 28 of whom had previous chest x rays. Of these 14 were found to be abnormal. A significant difference (p=0.007) in time from diagnosis to death was found between those with a missed abnormality, median (interquartile range, IQR) 105 (55-219) days and those with no previous abnormality, median (IQR) 260 (137-512) days. In the 14 in whom the diagnosis was missed the median (IQR) delay from first abnormal chest x ray to the eventual diagnostic x ray was 101 (48-339) days. A significant difference (p=0.001) was also found between the median (IQR) time from first abnormal chest x ray to start of treatment between those with missed abnormalities, 155 (115-376) days, and those with no previous abnormality on chest x ray, 51 (44-77) days. The most common reason (47%) for the diagnosis to be missed was failure of the radiologist reporting the x ray to recognise the abnormality. It is not unusual to find previous significant radiological abnormalities in patients in whom a diagnosis of lung cancer is later made. This leads to a diagnostic delay which has a significant effect on time to initiation of treatment and palliation of symptoms, although not necessarily to eventual outcome.
Authors:
P M Turkington; N Kennan; M A Greenstone
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Postgraduate medical journal     Volume:  78     ISSN:  0032-5473     ISO Abbreviation:  Postgrad Med J     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-03-08     Completed Date:  2002-04-18     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0234135     Medline TA:  Postgrad Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  158-60     Citation Subset:  IM    
Affiliation:
Department of Respiratory Medicine, Castle Hill Hospital, Cottingham, East Yorkshire, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Diagnostic Errors
False Negative Reactions
Humans
Lung Neoplasms / radiography*
Middle Aged
Retrospective Studies
Survival Rate
Time Factors
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