Pitfalls in the construction of cancer guidelines demonstrated by the analyses of colorectal referrals

摘要: INTRODUCTION: The aim of this study was to develop a system compare and validate cancer referral guidelines, identifying the pitfalls in their development provide mechanism evaluate efficacy. PATIENTS AND METHODS: 3302 patients referred from primary care with colorectal symptoms over 3-year period were assessed. All participants had comprehensive history obtained via questionnaire that incorporated all symptoms. questionnaires completed prior assessment at hospital. then assessed Colorectal One Stop Clinic (CROSC), underwent investigation diagnosis achieved. data entered into databank. Current prioritisation guidelines tools are used assess referrals applied databank test efficacy for detection prioritisation. Sensitivity specificity rates RESULTS: Cancer detected 156 (4.7%). models (NHS Weighted Numerical Score [WNS], Netherlands, Harvard, Mersey, Somerset) differentiated non-cancer patients. use few as risk predictors (e.g. NHS guidelines) causes decrease contrast tool, example, WNS score 50 54.1%, 62.9%). This results significantly higher rate 47.6%, 39.4%) identifies fewer cancers 80.1%, 85.9%). Non-evidence based modifications (Somerset Mersey) caused further deterioration specificity, which reflected an increased rate. Using WNS, is objective continuous scale, allows adaptation threshold, balancing sensitivity resources available within For > or = 40 has 96.8% detection. CONCLUSIONS: Accurate prospective collection bank testing well providing adjunct guideline construction.