Development and evaluation of a risk assessment tool to improve clinical triage accuracy for colonoscopic investigations

Lord, Anton R., Simms, Lisa A., Brown, Allison, Hanigan, Katherine, Krishnaprasad, Krupa, Schouten, Belinda, Croft, Anthony R., Appleyard, Mark N. and Radford-Smith, Graham L. (2018) Development and evaluation of a risk assessment tool to improve clinical triage accuracy for colonoscopic investigations. BMC Cancer, 18 1: 1-10. doi:10.1186/s12885-018-4140-0

Author Lord, Anton R.
Simms, Lisa A.
Brown, Allison
Hanigan, Katherine
Krishnaprasad, Krupa
Schouten, Belinda
Croft, Anthony R.
Appleyard, Mark N.
Radford-Smith, Graham L.
Title Development and evaluation of a risk assessment tool to improve clinical triage accuracy for colonoscopic investigations
Journal name BMC Cancer   Check publisher's open access policy
ISSN 1471-2407
Publication date 2018-02-27
Year available 2018
Sub-type Article (original research)
DOI 10.1186/s12885-018-4140-0
Open Access Status DOI
Volume 18
Issue 1
Start page 1
End page 10
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Subject 2730 Oncology
1311 Genetics
1306 Cancer Research
Abstract Background: 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. Methods: 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). Results: 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=2.86*10; diarrhoea, P=0.026; abdominal pain, P=5.67*10). 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=2.32*10), higher than the FIT test (OR=5.3, 95%CI 2.44-11.69, p=4.88*10), blood score (OR=2.8, 95%CI 1.72- 4.38, p=1.47*10) or age (OR=2.5, 95%CI 1.61-4.00, 5.12*10) 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). Conclusions: 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.
Keyword Bowel disease
Colorectal cancer
Faecal immunochemical test
Risk assessment tool
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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Created: Thu, 29 Mar 2018, 21:15:06 EST