Abstract 3215: Analysis of emergency department patients with known limb bone malignancies
Authors: Ladehoff Lauren C. , Taneja Kamil , Patel Karan , Shin Jeeyong , Chandragiri Sahas , Hsiung Hailey , Diaz Michael , Toloza Eric M. 
Published: April 2023

Introduction: Malignant neoplasms of the limb bones are rare. To our knowledge, there are few studies that analyze characteristics of these patients and reasons why they present to an emergency department (ED).

Methods: We utilized the 2006-2012 Nationwide Emergency Department Sample to characterize primary diagnoses and outcomes of limb bone cancer patients presenting to an ED. Multivariate logistic regression was used to identify factors associated with high chance of inpatient admission. A p-value ≤0.05 was significant.

Results: In this period, 4,020 limb bone cancer patients presented to the ED. Most patients were between ages of 18 and 29 (30.3%), male (58.1%), covered by private insurance (35.5%), in the second income quartile (26.3%), living in the South (35.3%), presenting to non-trauma hospitals (42.3%), and presenting to metropolitan teaching hospitals (53.0%). Most patients were admitted (64.9%) or discharged (29.1%). Most common primary diagnoses of the ED visit were white blood cell (WBC) disorders (8.6%), secondary malignancies (7.4%), pathologic disorder (5.9%), septicemia (4.8%), and central nervous system disorders (3.7%). Primary diagnoses associated with highest risk of inpatient admission were WBC disorder (odds ratio (OR)=21.1, 95% confidence interval (CI)=7.1-63.2; p&lt;0.001), pneumonia (OR=13.2, 95%CI=1.5-118.5, p=0.022), secondary malignancy (OR=11.1, 95%CI=3.4-36.3, p&lt;0.001), pathological fracture (OR=5.2, 95%CI=2.3-11.7, p&lt;0.001), and complication due to previous surgery or medical treatment (OR=3.9, 95%CI=1.4-11.4, p=0.012). Table 1 lists risks of inpatient admission associated with the 20 most common primary diagnoses.

Conclusion: Patients with limb bone cancers are young patients who present to the ED with WBC disorders, secondary malignancies, pathologic bone fractures, and infections. Clinicians should keep these conditions in mind when treating these patients.

Risk of Inpatient Admission Based on Primary Diagnosis in the Emergency Department Primary Diagnosis Odds Ratio (95% Confidence Interval) p-value White Blood Cell Disorder 21.1 (7.1-63.2) &lt;0.001 Pneumonia 13.2 (1.5-118.5) 0.022 Secondary Malignancy 11.1 (3.4-36.3) &lt;0.001 Pathologic Fracture 5.2 (2.3-11.7) &lt;0.001 Complication of Surgery or Medical Treatment 3.9 (1.36-11.4) 0.012 Complication of Device or Graft 3.8 (1.65-8.6) 0.002 Urinary Tract Infection 3.3 (1.14-9.6) 0.027 Anemia 3.0 (1.19-7.6) 0.020 Pleurisy or Pneumothorax 1.61 (0.33-7.8) 0.554 Arrhythmia 1.46 (0.39-5.5) 0.575 Skin Infection 1.13 (0.4-3.6) 0.829 Nervous System Disorder 1.10 (0.5-2.5) 0.826 Nausea or Vomiting 0.92 (0.32-2.6) 0.869 Fluid or Electrolyte Disorder 0.57 (0.14-2.3) 0.438 Fever 0.43 (0.15-1.19) 0.102 Chest Pain 0.23 (0.06-0.84 0.026 Connective Tissue Damage 0.11 (0.03-0.41) 0.001 Joint Disorder 0.10 (0.02-0.46) 0.003 Septicemia Not Available: All Admitted - Respiratory Failure Not Available: All Admitted -

Citation Format: Lauren C. Ladehoff, Kamil Taneja, Karan Patel, Jeeyong Shin, Sahas Chandragiri, Hailey Hsiung, Michael Diaz, Eric M. Toloza. Analysis of emergency department patients with known limb bone malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3215.