Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study
Background Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. Methods A 16-week, prospective, multicenter national service evaluat...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Wiley
2021
|
| _version_ | 1826258396559441920 |
|---|---|
| author | Hardman, JC Tikka, T Paleri, V Nirmal Kumar, B Jennings, C Repanos, C Stafford, F Ishii, H Wheatley, H Homer, J Jose, J McLaren, O Pracy, P Simo, R Sood, S Lester, S Winter, S Kerawala, C Ah‐See, K Gomati, A Cooper, F Thirumal, V Shakeel, M Asimakopoulos, P Rogers, M Loh, C Roode, M Kelly, A McCrory, D Khan, I Vijayakumar, S Hans, P Shenton, C Kallada, S Puvanendran, M Kiakou, M Wong, B Fletcher, L Harding, L Chaurasia, M Awad, Z Jaafar, M Cunning, N Bhatt, YM Jama, GM Sooriyamoorthy, T Galli, F Pinto, R Temple, R Ghaffar, S Et al. |
| author_facet | Hardman, JC Tikka, T Paleri, V Nirmal Kumar, B Jennings, C Repanos, C Stafford, F Ishii, H Wheatley, H Homer, J Jose, J McLaren, O Pracy, P Simo, R Sood, S Lester, S Winter, S Kerawala, C Ah‐See, K Gomati, A Cooper, F Thirumal, V Shakeel, M Asimakopoulos, P Rogers, M Loh, C Roode, M Kelly, A McCrory, D Khan, I Vijayakumar, S Hans, P Shenton, C Kallada, S Puvanendran, M Kiakou, M Wong, B Fletcher, L Harding, L Chaurasia, M Awad, Z Jaafar, M Cunning, N Bhatt, YM Jama, GM Sooriyamoorthy, T Galli, F Pinto, R Temple, R Ghaffar, S Et al. |
| author_sort | Hardman, JC |
| collection | OXFORD |
| description | Background
Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established.
Methods
A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator.
Results
Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382).
Conclusions
Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments.
|
| first_indexed | 2024-03-06T18:33:21Z |
| format | Journal article |
| id | oxford-uuid:0a690503-6d85-4c71-8193-1d67537504a0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:33:21Z |
| publishDate | 2021 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:0a690503-6d85-4c71-8193-1d67537504a02022-03-26T09:23:51ZRemote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:0a690503-6d85-4c71-8193-1d67537504a0EnglishSymplectic ElementsWiley2021Hardman, JCTikka, TPaleri, VNirmal Kumar, BJennings, CRepanos, CStafford, FIshii, HWheatley, HHomer, JJose, JMcLaren, OPracy, PSimo, RSood, SLester, SWinter, SKerawala, CAh‐See, KGomati, ACooper, FThirumal, VShakeel, MAsimakopoulos, PRogers, MLoh, CRoode, MKelly, AMcCrory, DKhan, IVijayakumar, SHans, PShenton, CKallada, SPuvanendran, MKiakou, MWong, BFletcher, LHarding, LChaurasia, MAwad, ZJaafar, MCunning, NBhatt, YMJama, GMSooriyamoorthy, TGalli, FPinto, RTemple, RGhaffar, SEt al.Background Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. Methods A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator. Results Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382). Conclusions Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments. |
| spellingShingle | Hardman, JC Tikka, T Paleri, V Nirmal Kumar, B Jennings, C Repanos, C Stafford, F Ishii, H Wheatley, H Homer, J Jose, J McLaren, O Pracy, P Simo, R Sood, S Lester, S Winter, S Kerawala, C Ah‐See, K Gomati, A Cooper, F Thirumal, V Shakeel, M Asimakopoulos, P Rogers, M Loh, C Roode, M Kelly, A McCrory, D Khan, I Vijayakumar, S Hans, P Shenton, C Kallada, S Puvanendran, M Kiakou, M Wong, B Fletcher, L Harding, L Chaurasia, M Awad, Z Jaafar, M Cunning, N Bhatt, YM Jama, GM Sooriyamoorthy, T Galli, F Pinto, R Temple, R Ghaffar, S Et al. Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study |
| title | Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study |
| title_full | Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study |
| title_fullStr | Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study |
| title_full_unstemmed | Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study |
| title_short | Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study |
| title_sort | remote triage incorporating symptom based risk stratification for suspected head and neck cancer referrals a prospective population based study |
| work_keys_str_mv | AT hardmanjc remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT tikkat remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT paleriv remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT nirmalkumarb remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT jenningsc remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT repanosc remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT staffordf remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT ishiih remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT wheatleyh remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT homerj remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT josej remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT mclareno remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT pracyp remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT simor remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT soods remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT lesters remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT winters remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT kerawalac remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT ahseek remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT gomatia remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT cooperf remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT thirumalv remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT shakeelm remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT asimakopoulosp remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT rogersm remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT lohc remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT roodem remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT kellya remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT mccroryd remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT khani remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT vijayakumars remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT hansp remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT shentonc remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT kalladas remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT puvanendranm remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT kiakoum remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT wongb remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT fletcherl remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT hardingl remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT chaurasiam remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT awadz remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT jaafarm remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT cunningn remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT bhattym remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT jamagm remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT sooriyamoorthyt remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT gallif remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT pintor remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT templer remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT ghaffars remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy AT etal remotetriageincorporatingsymptombasedriskstratificationforsuspectedheadandneckcancerreferralsaprospectivepopulationbasedstudy |