优化疑似 IBD 紧急转诊的分流:伯明翰 IBD 启动研究的结果

IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY Frontline Gastroenterology Pub Date : 2024-03-12 DOI:10.1136/flgastro-2023-102523
Peter Rimmer, Jonathan Cheesbrough, Jane Harris, Melanie Love, Samantha Tull, Asif Iqbal, Daniel Regan-Komito, Rachel Cooney, Karl Hazel, Naveen Sharma, Thomas Dietrich, Iain Chapple, Mohammad Nabil Quraishi, Tariq H Iqbal
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Results Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways. 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引用次数: 0

摘要

目的 炎症性肠病(IBD)的诊断延误会导致不良后果。我们报告了一个定制诊断路径,以评估如何最好地结合临床病史和粪便钙蛋白(FCP)进行早期诊断和有效利用资源。方法 对在紧急 "两周等待 "标准之外转诊的疑似 IBD 患者实施快速通道。根据症状和 FCP 对患者进行分流。在诊断前采集 13 点症状病史和临床指标,包括重复 FCP。结果 在767名患者中(2021年1月至2023年8月),423人被确诊为IBD(208名克罗恩病(CD)患者,215名溃疡性结肠炎(UC)患者)。克罗恩病最常见的症状是腹痛(84%)、便稀(84%)和疲劳(79%),溃疡性结肠炎最常见的症状是直肠周围出血(94%)、便急(82%)和便稀(81%)。最强的 IBD 预测因子是大便混血(CD OR 4.38;95% CI 2.40-7.98,UC OR 33.68;15.47-73.33)和体重减轻(CD OR 3.39;2.14-5.38,UC OR 2.33;1.37-4.00)。重复 FCP 检测显示,非 IBD 患者的 FCP 值较基线值有所下降。测量值>100 µg/g(曲线下面积(AUC)0.800)和>200 µg/g(AUC 0.834)共同预测了 IBD。然而,不管第一个结果如何,单独考虑第二个≥220 µg/g的值更准确(尤登指数 0.735,AUC 0.923)。将症状与 FCP 建立模型可将 AUC 提高到 0.947。结论 连续测量 FCP 可避免不必要的结肠镜检查。两次 FCP >200 µg/g 可使患者直接接受结肠镜检查,两次 >100 µg/g 可促使患者接受门诊复查。第二次结果≥220 µg/g比双重结果阈值更准确。将家庭 FCP 检测与主要症状相结合,可为有效的自我转诊途径奠定基础。如有合理要求,可提供相关数据。
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Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study
Objective Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively. Results Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways. Data are available upon reasonable request.
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来源期刊
Frontline Gastroenterology
Frontline Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.70
自引率
11.50%
发文量
93
期刊介绍: Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
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