Prediction of colorectal cancer by a patient consultation questionnaire and scoring system: a prospective study.
Background: Current NHS guidelines for referral of patients with colorectal symptoms classify many as high risk but fail to identify a significant number of cancers in the low-risk group. We describe a practical scoring method to predict colorectal cancers.Methods: From October, 1999, 2268 patients...
| Publicado en: | Lancet Vol. 360; no. 9329; pp. 278 - 284 |
|---|---|
| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Lancet
7/27/2002
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106965700&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106965700 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 7/27/2002 vid: 360 iid: 9329 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 106965700 106965700 NLM12147370 2002132028 10.1016/s0140-6736(02)09549-1 NLM12147370 106965700 ppf: 278 ppct: 6 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Prediction of colorectal cancer by a patient consultation questionnaire and scoring system: a prospective study. aug: au: Selvachandran SN Hodder RJ Ballal MS Jones P Cade D Selvachandran, S N Hodder, R J Ballal, M S Jones, P Cade, D affil: Department of Surgery, Leighton Hospital, Mid Cheshire Hospital Trust, Crewe, Cheshire, UK sug: subj: Colorectal Neoplasms Risk Factors Clinical Assessment Tools Risk Assessment Methods United Kingdom National Health Programs Confidence Intervals McNemar's Test Sensitivity and Specificity Questionnaires Prospective Studies Colorectal Neoplasms Classification Patient History Taking Predictive Value of Tests Chi Square Test Relative Risk Referral and Consultation Age Factors Colorectal Neoplasms Symptoms Colorectal Neoplasms Diagnosis Adult Middle Age Human Adult: 19-44 years Middle Aged: 45-64 years ab: Background: Current NHS guidelines for referral of patients with colorectal symptoms classify many as high risk but fail to identify a significant number of cancers in the low-risk group. We describe a practical scoring method to predict colorectal cancers.Methods: From October, 1999, 2268 patients with distal colonic symptoms, referred by general practitioners, completed a patient consultation questionnaire linked to a computerised record. Referrals were prioritised with a malignancy risk score by a senior colorectal surgeon separately from the general practitioner's letter and from the questionnaire. A weighted numerical score was derived from weighting of primary symptoms and symptom complexes and was calculated automatically when the questionnaire data were entered into the computer program. Analysis by receiver-operating characteristics assessed the scoring systems. Sensitivities and specificities of scoring systems were compared with McNemar's test.Findings: Of the 2268 patients, 95 had colorectal cancer. The average weighted numerical score was significantly higher for patients with cancer than for non-cancer patients (mean 76.5 [95% CI 72.2-80.9] vs 44.5 [43.6-45.4]; p<0.0001). At similar cancer detection rates, the malignancy risk score derived from the patient consultation questionnaire and the weighted numerical score graded lower proportions of referrals as urgent than did the current NHS guidelines (43.1% and 39.8% vs 49.8%; p<0.0001).Interpretation: The patient consultation questionnaire depends on history alone and is easily reproducible. In conjunction with the weighted numerical score, which removes operator bias, it can be used as an accurate system for prediction of symptomatic colorectal cancer. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|