Evidence map›Paper›PMID 21619747›Full record

SynthesisThe British journal of general practice : the journal of the Royal College of General Practitioners2011

The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review.

Margaret Astin, Tom Griffin, Richard D Neal, Peter Rose, William Hamilton

Open access · bronzeAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The British journal of general practice : the journal of the Royal College of General Practitioners, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 127 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
127citing papers in PubMed, 12 pooled it
7.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

127 citing papers in PubMed, 12 syntheses or guidelines pooled it, 264 citations in OpenAlex.

  1. Pooled it
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  6. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020.Journal of the National Comprehensive Cancer Network : JNCCN · 2020
    Guideline
  7. Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019
    Pooled it
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  9. Weight loss as a predictor of cancer in primary care: a systematic review and meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018
    Pooled it
  10. Predictive values of referrals for transient ischaemic attack from first-contact health care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017
    Pooled it
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  12. Systematic review of clinical features of suspected colorectal cancer in primary care.Canadian family physician Medecin de famille canadien · 2014
    Pooled it
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67 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Margaret AstinUniversity of Bristol, Academic Unit of Primary Health Care, Bristol, UK.
Tom Griffin
Richard D Neal
Peter Rose
William Hamilton
Cardiff University · GBUniversity of Bristol · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOver 37,000 new colorectal cancers are diagnosed in the UK each year. Most present symptomatically to primary care.

aimTo conduct a systematic review of the diagnostic value of symptoms associated with colorectal cancer.

designSystematic review.

methodMEDLINE, Embase, Cochrane Library, and CINAHL were searched to February 2010, for diagnostic studies of symptomatic adult patients in primary care. Studies of asymptomatic patients, screening, referred populations, or patients with colorectal cancer recurrences, or with fewer than 100 participants were excluded. The target condition was colorectal cancer. Data were extracted to estimate the diagnostic performance of each symptom or pair of symptoms. Data were pooled in a meta-analysis. The quality of studies was assessed with the QUADAS tool.

resultsTwenty-three studies were included. Positive predictive values (PPVs) for rectal bleeding from 13 papers ranged from 2.2% to 16%, with a pooled estimate of 8.1% (95% confidence interval [CI] = 6.0% to 11%) in those aged ≥ 50 years. Pooled PPV estimates for other symptoms were: abdominal pain (three studies) 3.3% (95% CI = 0.7% to 16%); and anaemia (four studies) 9.7% (95% CI = 3.5% to 27%). For rectal bleeding accompanied by weight loss or change in bowel habit, pooled positive likelihood ratios (PLRs) were 1.9 (95% CI = 1.3 to 2.8) and 1.8 (95% CI = 1.3 to 2.5) respectively, suggesting higher risk when both symptoms were present. Conversely, the PLR was one or less for abdominal pain, diarrhoea, or constipation accompanying rectal bleeding.

conclusionThe findings suggest that investigation of rectal bleeding or anaemia in primary care patients is warranted, irrespective of whether other symptoms are present. The risks from other single symptoms are lower, though multiple symptoms also warrant investigation.

Indexed as

General PracticeReferral and ConsultationAbdominal PainColorectal NeoplasmsConstipationDiarrheaGastrointestinal HemorrhageHumansPredictive Value of TestsWeight Loss

Identifiers

PMID21619747
PMCPMC3080228
OpenAlexW2068382972

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.