Age and symptoms as a triage method for per‐rectal bleeding

Abstract

Objective: Per-rectal bleeding is a common reason of surgical referral. The average waiting time in a busy clinic could be months, which should preferably be shortened for potentially serious cases. With little information on referral letters, other methods for triage have to be searched for. Age and symptoms as triage methods were evaluated. Methods: Data from patients attending the United Christian Hospital specialist clinic for per-rectal bleeding were collected prospectively. The association between age and the prevalence of colorectal neoplasia was analysed. The most suitable cut-off age was determined by a receiving operating characteristic (ROC) curve. For symptoms, a questionnaire to check for high-risk features of per-rectal bleeding was designed. Non-medically trained volunteers were instructed to interview each patient before the surgical consultation. A positive result for the questionnaire is the presence of high-risk features. The surgeons were unaware of the questionnaires’ findings. The results were compared with the final diagnosis. Positive diagnoses were defined as either malignancy or significant polyps. The sensitivity and specificity of age and the questionnaire were computed. Results: A total of 194 patients were interviewed. Twenty patients declined colonoscopy and were excluded, leaving 174 for analysis. The ROC curve showed 60 years to be the most suitable age for triage. The sensitivity and specificity of age (≥ 60 years old) was 73.1% and 62.8%, respectively. The sensitivity and specificity of the questionnaire was 65.4% and 55.4%, respectively. The positive predictive value of age was 25.7%, which was increased to 33.6% with a positive questionnaire result. The negative predictive value of 93.0% by age alone was increased to 95.5% with a negative questionnaire result. Conclusion: Age is a very effective triage criterion. Using 60 years of age as a cut-off point screens out low-risk patients effectively. A preconsultation-structured interview designed to identify high-risk symptoms has little additional triage benefit. Chinese Abstract Figure Chinese Abstract. Figure Chinese Abstract. Figure Chinese Abstract. Figure Chinese Abstract. Figure Chinese Abstract.