Evidence map›Paper›PMID 29302885›Full record

ArticleJournal of general internal medicine2018

Diagnostic Evaluation of Patients Presenting to Primary Care with Rectal Bleeding.

Sanja Percac-Lima, Lydia E Pace, Kevin H Nguyen, Charis N Crofton, Katharine A Normandin, Sara J Singer, Meredith B Rosenthal, Alyna T Chien

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

Article in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
0.6field-weighted citation impact, top 30% 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

7 citing papers in PubMed, 9 citations in OpenAlex.

  1. Article
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  5. Yonder: Patient complaints, after-visit summaries, rectal bleeding, and the doorknob phenomenon.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018
    Article
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  7. Observational
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Sanja Percac-LimaHarvard Medical School, Boston, MA, USA. SPERCACLIMA@mgh.harvard.edu.
Lydia E PaceHarvard Medical School, Boston, MA, USA.
Kevin H NguyenDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Charis N CroftonDivision of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
Katharine A NormandinDivision of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
Sara J SingerHarvard Medical School, Boston, MA, USA.
Meredith B RosenthalDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Alyna T ChienHarvard Medical School, Boston, MA, USA.
Harvard University · USBoston Children's Hospital · USMassachusetts General Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRectal bleeding is a common, frequently benign problem that can also be an early sign of colorectal cancer. Diagnostic evaluation for rectal bleeding is complex, and clinical practice may deviate from available guidelines.

objectiveTo assess the degree to which primary care physicians document risk factors for colorectal cancer among patients with rectal bleeding and order colonoscopies when indicated, and the likelihood of physicians ordering and patients receiving recommended colonoscopies based on demographic characteristics, visit patterns, and clinical presentations.

designCross-sectional study using explicit chart abstraction methods.

participantsThree hundred adults, 40-80 years of age, presenting with rectal bleeding to 15 academically affiliated primary care practices between 2012 and 2016. MAIN MEASURES: 1) The frequency at which colorectal cancer risk factors were documented in patients' charts, 2) the frequency at which physicians ordered colonoscopies and patients received them, and 3) the odds of ordering and patients receiving recommended colonoscopies based on patient demographic characteristics, visit patterns, and clinical presentations. KEY

resultsRisk factors for colorectal cancer were documented between 9% and 66% of the time. Most patients (89%) with rectal bleeding needed a colonoscopy according to a clinical guideline. Physicians placed colonoscopy orders for 74% of these patients, and 56% completed the colonoscopy within a year (36% within 60 days). The odds of physicians ordering recommended colonoscopies were significantly higher in patients aged 50-64 years of age than in those aged 40-50 years (OR = 2.23, 95% CI: 1.04, 4.80), and for patients whose most recent colonoscopy was 5 or more years ago (OR = 4.04, 95% CI: 1.50, 10.83). The odds of physicians ordering and patients receiving recommended colonoscopies were significantly lower for each primary care visit unrelated to rectal bleeding (OR = 0.85, 95% CI: 0.75, 0.96).

conclusionsDiagnostic evaluation of patients presenting to primary care with rectal bleeding may be suboptimal because of inadequate risk factor assessment and prioritization of patients' other concurrent medical problems.

Indexed as

RectumAdultAgedAged, 80 and overColonoscopyColorectal NeoplasmsCross-Sectional StudiesDiagnosis, DifferentialFemaleGastrointestinal HemorrhageHumansMaleMiddle AgedPrimary Health CareRisk Factorshealth services researchpatient safetyprimary carerectal bleeding

Identifiers

PMID29302885
PMCPMC5880768
OpenAlexW2781882799

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.