Inflammatory Bowel Diseases, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
BMC Cancer. 2018 Feb 27;18(1):229. doi: 10.1186/s12885-018-4140-0.
Gastroenterology Departments at hospitals within Australia receive thousands of General Practitioner (GP)-referral letters for gastrointestinal investigations every month. Many of these requests are for colonoscopy. This study aims to evaluate the performance of the current symptoms-based triage system compared to a novel risk score using objective markers.
Patients with lower abdominal symptoms referred by their GPs and triaged by a Gastroenterology consultant to a colonoscopy consent clinic were recruited into the study. A risk assessment tool (RAT) was developed using objective data (clinical, demographic, pathology (stool test, FIT), standard blood tests and colonoscopy outcome). Colonoscopy and histology results were scored and then stratified as either significant bowel disease (SBD) or non-significant bowel disease (non-SBD).
Of the 467 patients in our study, 45.1% were male, the mean age was 54.3 ± 13.8 years and mean BMI was 27.8 ± 6.2. Overall, 26% had SBD compared to 74% with non-SBD (42% of the cohort had a normal colonoscopy). Increasing severity of referral symptoms was related to a higher triage category, (rectal bleeding, P = 2.8610; diarrhoea, P = 0.026; abdominal pain, P = 5.6710). However, there was no significant difference in the prevalence of rectal bleeding (P = 0.991) or diarrhoea (P = 0.843) for SBD. Abdominal pain significantly reduced the risk of SBD (P = 0.0344, OR = 0.52, CI = 0.27-0.95). Conversely, the RAT had a very high specificity of 98% with PPV and NPV of SBD prediction, 74% and 77%, respectively. The RAT provided an odds ratio (OR) of 9.0, 95%CI 4.29-18.75, p = 2.3210), higher than the FIT test (OR = 5.3, 95%CI 2.44-11.69, p = 4.8810), blood score (OR = 2.8, 95%CI 1.72- 4.38, p = 1.4710) or age (OR = 2.5, 95%CI 1.61-4.00, 5.1210) independently. Notably, the ORs of these individual objective measures were higher than the current practice of symptoms-based triaging (OR = 1.4, 95%CI 0.88-2.11, p = 0.153).
It is critical that individuals with high risk of having SBD are triaged to the appropriate category with the shortest wait time. Here we provide evidence that a combination of blood markers, demographic markers and the FIT test have a higher diagnostic accuracy for SBD than FIT alone.
澳大利亚医院的胃肠病科每月都会收到数千封由全科医生 (GP) 转介的胃肠道检查的信件。其中许多请求是进行结肠镜检查。本研究旨在评估当前基于症状的分诊系统与使用客观标志物的新型风险评分的表现。
通过胃肠病学顾问将有下腹部症状的患者由他们的全科医生转诊至结肠镜检查同意诊所，并招募到该研究中。使用客观数据（临床、人口统计学、病理学（粪便检查、FIT）、标准血液检查和结肠镜检查结果）开发了一种风险评估工具 (RAT)。对结肠镜检查和组织学结果进行评分，然后分为有显著肠道疾病 (SBD) 或无显著肠道疾病 (非 SBD)。
在我们的研究中，467 名患者中 45.1%为男性，平均年龄为 54.3±13.8 岁，平均 BMI 为 27.8±6.2。总体而言，26%的患者有 SBD，而非 SBD 为 74%（队列中有 42%的患者结肠镜检查正常）。严重程度较高的转诊症状与较高的分诊类别相关（直肠出血，P=2.8610；腹泻，P=0.026；腹痛，P=5.6710）。然而，SBD 患者的直肠出血（P=0.991）或腹泻（P=0.843）的发生率无显著差异。腹痛显著降低了 SBD 的风险（P=0.0344，OR=0.52，CI=0.27-0.95）。相反，RAT 的特异性非常高，为 98%，SBD 预测的阳性预测值和阴性预测值分别为 74%和 77%。RAT 提供了 9.0 的优势比 (OR)，95%CI 为 4.29-18.75，p=2.3210），高于 FIT 测试（OR=5.3，95%CI 2.44-11.69，p=4.8810）、血液评分（OR=2.8，95%CI 1.72-4.38，p=1.4710）或年龄（OR=2.5，95%CI 1.61-4.00，p=5.1210）。值得注意的是，这些单个客观指标的优势比高于当前基于症状的分诊（OR=1.4，95%CI 0.88-2.11，p=0.153）。
重要的是，具有高 SBD 风险的个体应通过最短的等待时间被分诊至适当类别。在这里，我们提供的证据表明，血液标志物、人口统计学标志物和 FIT 测试的组合比单独使用 FIT 具有更高的 SBD 诊断准确性。
