ArticleBMJ (Clinical research ed.)2009
Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study.
Article in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 79 citations in OpenAlex.
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- The National Oesophagogastric Cancer Awareness Campaign: a locality outcome analysis from County Durham.Frontline gastroenterology · 2017Article
- Approach to Hemoptysis in the Modern Era.Canadian respiratory journal · 2017Review
- Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study.BMJ open · 2015Article
- Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation.British journal of cancer · 2015Review
- Variation in promptness of presentation among 10,297 patients subsequently diagnosed with one of 18 cancers: evidence from a National Audit of Cancer Diagnosis in Primary Care.International journal of cancer · 2014Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care.
designCohort study using the general practice research database.
setting128 general practices in the UK contributing data, 1994-2000.
participants762 325 patients aged 15 or older.
main outcome measuresUp to 15 pre-specified, non-cancer diagnoses associated with four alarm symptoms (haematuria, haemoptysis, dysphagia, rectal bleeding) at 90 days and three years after the first recorded alarm symptom. For each outcome analyses were implemented separately in a time to event framework. Data were censored if patients died, left the practice, or reached the end of the study period.
resultsWe analysed data on first episodes of haematuria (11 108), haemoptysis (4812), dysphagia (5999), or rectal bleeding (15 289). Non-cancer diagnoses were common in patients who presented with alarm symptoms. The proportion diagnosed with either cancer or non-cancer diagnoses generally increased with age. In patients presenting with haematuria, the proportions diagnosed with either cancer or non-cancer diagnoses within 90 days were 17.5% (95% confidence interval 16.4% to 18.6%) in women and 18.3% (17.4% to 19.3%) in men. For the other symptoms the proportions were 25.7% (23.8% to 27.8%) and 24% (22.5% to 25.6%) for haemoptysis, 17.2% (16% to 18.5%) and 22.6% (21% to 24.3%) for dysphagia, and 14.5% (13.7% to 15.3%) and 16.7% (15.8% to 17.5%) for rectal bleeding.
conclusionClinically relevant diagnoses are made in a high proportion of patients presenting with alarm symptoms. For every four to seven patients evaluated for haematuria, haemoptysis, dysphagia, or rectal bleeding, relevant diagnoses will be identified in one patient within 90 days.
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