Evidence map›Paper›PMID 40716790›Full record

Observational studyBMJ open gastroenterology2025

Triaging colorectal urgent referrals in the COVID-19 era using faecal immunochemical testing: a prospective UK real-world multicentre cohort study.

Gareth Walker, Supriya Balasubramanya, Joel Bowen, Nedal Debab, Robert Bethune, William Faux, Naomi Spencer, Venla Kantola, Mark Feeney, Sebastian Smolarek and 9 more

Abstract readMulticenter StudyObservational Study
In one paragraph

Observational study in BMJ open gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Gareth WalkerGastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia Gareth.Walker@health.qld.gov.au.ORCID http://orcid.org/0000-0002-3883-8816
Supriya BalasubramanyaColorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK.
Joel BowenColorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK.ORCID http://orcid.org/0000-0002-7458-4251
Nedal DebabColorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
Robert BethuneColorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
William FauxColorectal Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK.
Naomi SpencerColorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
Venla KantolaColorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.ORCID http://orcid.org/0000-0002-4668-7915
Mark FeeneyGastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK.ORCID http://orcid.org/0000-0002-2816-4256
Sebastian SmolarekColorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK.
Sarah E R BaileyPrimary Care Diagnostics, University of Exeter, Exeter, UK.ORCID http://orcid.org/0000-0003-0020-4778
Willie HamiltonPrimary Care Diagnostics, University of Exeter, Exeter, UK.ORCID http://orcid.org/0000-0003-1611-1373
Sally Ward-BoothColorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
Timothy McDonaldThe Exeter Blood Sciences Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
Iain BainNorth Devon District Hospital, Barnstaple, UK.
John RenninsonPeninsula Cancer Alliance, Dartington, UK.
Nicholas A KennedyGastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.ORCID http://orcid.org/0000-0003-4368-1961
Mark CartmellColorectal Surgery, North Devon District Hospital, Barnstaple, UK.
Southwest FIT Audit Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveDuring the early COVID-19 pandemic, UK guidelines advocated faecal immunochemical tests (FIT) with a threshold of 10 µg/g to help secondary care clinicians triage urgent suspected colorectal cancer (CRC) referrals. We aimed to evaluate the real-world performance and impact of FIT in a high-risk cohort referred against National Institute for Health and Clinical Excellence NG12 (2015) criteria.

methodsMulticentre prospective observational cohort study of FIT at all four secondary care hospitals in Devon (UK) between 1 April 2020 and 31 December 2020. FIT use was at the discretion of primary and secondary care clinicians. Incident CRC cases were identified ≥12 months after general practitioner (GP) referral using regional National Bowel Cancer Audit data linkage. We assessed diagnostic accuracy and healthcare utilisation in patients with and without FIT.

resultsOverall, 6698 patients were included: 55% female, median age 72 years (IQR 65-82). Just over half (53%, 3552) of patients underwent FIT with a positivity rate of 34% (n=1237). CRC prevalence in patients with no FIT, positive FIT and negative FIT was 6% (189), 11% (137) and 0.5% (11), respectively. The prevalence of all cancers, including non-CRCs, was similar among FIT and no-FIT cohorts (p=0.74). Sensitivity and specificity of FIT for CRC were 0.93 (95% CI 0.87 to 0.96) and 0.68 (95% CI 0.66 to 0.69), respectively. Patients with negative FIT underwent fewer lower gastrointestinal endoscopies (no FIT 62% (1964) vs positive FIT 69% (857) vs negative FIT 36% (835)), p=0.0005).

conclusionsFIT is a useful triage tool for patients with suspected CRC which safely reduces endoscopy demand and prioritises those at greatest cancer risk. Standardised regional referral pathways, greater use of 'straight-to-test' investigations and GP support are needed to maximise its impact.

Indexed as

Colorectal NeoplasmsCOVID-19Early Detection of CancerOccult BloodReferral and ConsultationTriageAgedAged, 80 and overFemaleHumansMaleProspective StudiesSARS-CoV-2United KingdomCLINICAL DECISION MAKINGCOLORECTAL CANCERCOLORECTAL NEOPLASM

Identifiers

PMID40716790
PMCPMC12306339

What OpenQuestion holds

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LicenceCC BY-NC
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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.