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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 2003 Jul;85(4):272–276. doi: 10.1308/003588403766275015

Analysis of the referral pattern to a supraregional bone and soft tissue tumour service.

N Ashwood 1, J D Witt 1, P J Hallam 1, J P Cobb 1
PMCID: PMC1964394  PMID: 12855033

Abstract

AIM: To investigate the sources of delay in diagnosis and determine if there was a similar diagnostic error rate as found by the Musculoskeletal Tumour Society, which subsequently altered patients' management and affected outcome. PATIENTS AND METHODS: A prospective review of 100 consecutive patients referred to our institution analysed causes for delay in referral and whether prior investigations or procedures had complicated further management. RESULTS: Patients were symptomatic for 14.8 months (range, 0-26 months) prior to consultation with their GP. A further 13.5 months (range, 0.5-120 months) elapsed before referral by the local hospital (94) or GP (6) to the bone and soft tissue service. A significant delay in referral of more than a month occurred in 72 patients. Those patients with malignant disease were symptomatic for 7.6 months (range, 0.5-11 months) prior to seeking medical advice with a further 7.5 months (range, 0-13 months) elapsing prior to onward referral at their local hospital. From the study group, 63 patients were subjected to complex imaging studies (bone scan, CT, MRI) prior to referral; 34 biopsies or surgery were performed in 34 cases by referring teams, 16 of which complicated subsequent management. CONCLUSIONS: If a high suspicion of a soft tissue or bone tumour is suspected from the history, examination and plain radiograph, then early referral to a specialist centre is recommended where relevant, high-quality investigations can be arranged in a short time leading to a planned biopsy, confirmation of diagnosis and definitive treatment at an earlier stage.

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