Howlett J, Singer J, Lee T, Hu A. Time to Laryngoscopy for Hoarseness in Canada: Are the American Academy of Otolaryngology Guidelines Feasible?
OTO Open 2020;
4:2473974X20932500. [PMID:
32548543 PMCID:
PMC7273574 DOI:
10.1177/2473974x20932500]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives
To determine if a Canadian voice center is meeting the recommended time to
laryngoscopy for hoarseness per the clinical practice guideline of the
American Academy of Otolaryngology–Head and Neck Surgery.
Study Design
Retrospective chart audit.
Setting
Tertiary referral Canadian voice center.
Participants and Methods
A total of 149 adult patients presenting with hoarseness over 6 months were
included. Primary outcome measures were the time from onset of symptoms to
laryngoscopy and the time from referral to laryngoscopy. Secondary outcome
measures included patient- and disease-modifying factors, diagnosis, and
clinical management. Analysis was performed to determine what factors were
associated with meeting the guideline.
Results
Patients were evaluated by the laryngologist after 21.9 ± 37.6 months (mean ±
SD) of symptoms. One-third (34.2%) of patients were seen within 3 months;
10.7% were seen within 4 weeks. Logistic regression showed that patients
with neurologic symptoms (odds ratio, 4.04; 95% CI, 1.31-12.43;
P = .015) and endotracheal intubation (odds ratio,
5.94; 95% CI, 2.21-15.95; P < .001) were associated with
being seen within 3 months. Patients who had recent intubation (odds ratio,
6.04; 95% CI, 1.99-18.34; P = .002) were associated with
being seen within 4 weeks.
Conclusion
It is an ongoing challenge for our Canadian voice center to meet the American
Academy of Otolaryngology–Head and Neck Surgery’s clinical practice
guideline for recommended time to laryngoscopy. Patients with more severe
pathologies were consistently triaged more urgently. It is debatable whether
this 4-week time recommendation is generalizable to a socialized health care
system.
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