Table 2

Description of prehospital care factors

Variables	Diagnostic pathways										Total (N=513)		P value*
	Self-presentation to ED (N=112)		Family physician referral to ED (N=75)		Referral to elective gynaecology/ oncogynecology from family physician (N=109)		Referral to elective gynaecology/ oncogynecology care from other specialist (N=162)		Other/unknown (N=55)		Total (N=513)
	n	%	n	%	n	%	n	%	n	%	n	%
Presenting symptom
Pelvic/abdominal pain/discomfort	62	55.4	36	48.0	60	55.0	55	34.0	25	45.5	238	46.4	0.002†
Change in appetite/feeling full	8	7.1	3	4.0	4	3.7	2	1.2	2	3.6	19	3.7	0.17
Abdominal distension/bloating	34	30.4	9	12.0	12	11.0	15	9.3	7	12.7	77	15.0	<0.001†
Urinary frequency/urgency	15	13.4	10	13.3	19	17.4	18	11.1	6	10.9	68	13.3	0.63
Change in bowel movements (constipation/diarrhoea)	24	21.4	11	14.7	15	13.8	16	9.9	6	10.9	72	14.0	0.096
Back pain	14	12.5	13	17.3	15	13.8	26	16.0	4	7.3	72	14.0	0.47
Other	1	0.9	1	1.3	0	0.0	1	0.6	0	0.0	3	0.6	0.76
Presenting signs
Ascites	10	8.9	4	5.3	0	0.0	3	1.9	3	5.5	20	3.9	0.006†
Pelvic/abdominal mass	11	9.8	4	5.3	13	11.9	12	7.4	8	14.5	48	9.4	0.31
Pleural effusion	5	4.5	6	8.0	0	0.0	0	0.0	0	0.0	11	2.1	<0.001†
Umbilical nodule/abdominal mass	2	1.8	3	4.0	1	0.9	2	1.2	1	1.8	9	1.8	0.58
Asthenia, anorexia, weight loss	7	6.3	7	9.3	4	3.7	8	4.9	2	3.6	28	5.5	0.49
Deep vein thrombosis	3	2.7	3	4.0	1	0.9	0	0.0	0	0.0	7	1.4	0.076
Lymphadenopathies	0	0.0	0	0.0	2	1.8	1	0.6	0	0.0	3	0.6	0.36
Vaginal abnormal bleeding	14	12.5	6	8.0	24	22.0	26	16.0	4	7.3	74	14.4	0.032†
Other	15	13.4	19	25.3	8	7.3	11	6.8	3	5.5	56	10.9	0.001†
Asymptomatic	1	0.9	0	0.0	3	2.8	41	25.3	10	18.2	55	10.7	<0.001†
Symptomatic profiles
Nonspecific symptoms	66	58.9	44	58.7	62	56.9	74	45.7	28	50.9	274	53.4	<0.001†
Gynaecological symptoms (vaginal bleeding)	13	11.6	6	8.0	23	21.1	24	14.8	4	7.3	70	13.6
Signs associated with advanced disease	32	28.6	25	33.3	21	19.3	23	14.2	13	23.6	114	22.2
Asymptomatic	1	0.9	0	0.0	3	2.8	41	25.3	10	18.2	55	10.7
Start point (first consultation)
Primary care	65	58.0	75	100.0	109	100.0	119	73.5	16	29.1	384	74.9	<0.001†
Other	47	42.0	0	0.0	0	0.0	43	26.5	39	70.9	129	25.1
Reason for referral
Physical examination: ascites	28	25.0	15	20.0	5	4.6	6	3.7	15	27.3	69	13.5	<0.001†
Physical examination: pelvic mass	22	19.6	14	18.7	18	16.5	16	9.9	7	12.7	77	15.0	0.17
Imaging technique	78	69.6	36	48.0	73	67.0	107	66.0	36	65.5	330	64.3	0.031†
Tumour marker	5	4.5	6	8.0	9	8.3	14	8.6	9	16.4	43	8.4	0.15
Pathological anatomy and cytology	3	2.7	11	14.7	6	5.5	28	17.3	7	12.7	55	10.7	<0.001†
Professional making the referral to gynaecologist/oncogynecologist
Family physician	1	0.9	18	24.0	64	58.7	5	3.1	0	0.0	88	17.2	<0.001†
Emergency physician	94	83.9	33	44.0	0	0.0	4	2.5	3	5.5	134	26.1
ASSIR services gynaecologist	0	0.0	0	0.0	31	28.4	47	29.0	0	0.0	78	15.2
Hospital gynaecologist	3	2.7	1	1.3	11	10.1	47	29.0	5	9.1	67	13.1
Other specialists	14	12.5	23	30.7	1	0.9	59	36.4	0	0.0	97	18.9
Outside the public system	0	0.0	0	0.0	2	1.8	0	0.0	47	85.5	49	9.6
No of referrals (not including referrals to gynaecologist/oncogynecologist)
0	57	50.9	0	0.0	32	29.4	63	38.9	31	56.4	183	35.7	<0.001†
1	40	35.7	34	45.3	49	45.0	70	43.2	20	36.4	213	41.5
2	14	12.5	25	33.3	20	18.3	24	14.8	3	5.5	86	16.8
≥3	1	0.9	16	21.3	8	7.3	5	3.1	1	1.8	31	6.0
Visits to family medicine§
N, mean (SD)	6.3 (6.3)		9.1 (7.6)		10.2 (8.1)		7.0 (8.0)		5.1 (5.8)		7.6 (7.6)		<0.001†‡
Median (IQR)	5.0 (10.0)		7.0 (8.0)		8.0 (12.0)		5.0 (9.0)		3.0 (6.0)		6.0 (9.0)
Emergency visits§
N, mean (SD)	1.1 (1.3)		0.9 (1.1)		0.8 (3.0)		0.6 (1.2)		0.6 (1.5)		0.8 (1.8)		<0.001†‡
Median (IQR)	1.0 (2.0)		1.0 (1.0)		0.0 (1.0)		0.0 (1.0)		0.0 (1.0)		0.0 (1.0)

*P value: χ² test.
†Statistical significance (p<0.05).
‡Kruskal-Wallis test
§In the last 18 months
.ASSIR, sexual health and reproductive care centres; ED, emergency department.