Fijten G H, Starmans R, Muris J W, Schouten H J, Blijham G H, Knottnerus J A
Diagnostic Coordination Centre, University Hospital, Maastricht, The Netherlands.
Fam Pract. 1995 Sep;12(3):279-86. doi: 10.1093/fampra/12.3.279.
The aim of the study is to determine the diagnostic value of (combinations of) signs, symptoms and simple laboratory test results for colorectal cancer in patients with rectal bleeding presenting in general practice. Initial complaints and findings were compared with the final diagnoses based on clinical follow-up after at least 1 year. Patients studied were those presenting overt rectal bleeding to the general practitioner (83 GPs in the South of the Netherlands). Outcome measures are sensitivity, specificity, predictive values, odds ratios and a prediction model derived from multiple logistic regression analysis. Age, change in bowel habit and blood mixed with or on stool show a statistically significant independent value in the discrimination between patients with a low and those with a high probability of colorectal cancer. Many other variables did not show predictive value. The prediction model has a sensitivitiy of 100% and a specificity of 90%. Although the number of patients with colorectal cancer is small (n = 9) it was possible to identify three characteristics which can be helpful in the prediction of presence or absence of colorectal cancer in general practice. Application of the model presented might prevent 90% of 'unnecessary' invasive diagnostic procedures for patients with rectal bleeding who do not have colorectal cancer (true negative). Testing the performance of the model in other general practice populations is recommended.
本研究的目的是确定在全科医疗中出现直肠出血的患者身上，体征、症状及简单实验室检查结果（及其组合）对结直肠癌的诊断价值。将初始症状和检查结果与至少1年后临床随访得出的最终诊断结果进行比较。研究对象为向全科医生（荷兰南部的83名全科医生）表现出明显直肠出血症状的患者。观察指标为敏感性、特异性、预测值、比值比以及通过多元逻辑回归分析得出的预测模型。年龄、排便习惯改变以及粪便中混合或附着血液在区分结直肠癌低概率患者和高概率患者方面显示出具有统计学意义的独立价值。许多其他变量未显示出预测价值。该预测模型的敏感性为100%，特异性为90%。尽管结直肠癌患者数量较少（n = 9），但仍有可能确定三个有助于在全科医疗中预测结直肠癌存在与否的特征。应用所提出的模型可能会避免90%针对无结直肠癌的直肠出血患者（真阴性）的“不必要”侵入性诊断程序。建议在其他全科医疗人群中测试该模型的性能。
