Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study.
OBJECTIVE
To evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care.


METHODS
Cohort study using the general practice research database.


METHODS
128 general practices in the UK contributing data, 1994-2000.


METHODS
762 325 patients aged 15 or older.


METHODS
Up to 15 pre-specified, non-cancer diagnoses associated with four alarm symptoms (haematuria, haemoptysis, dysphagia, rectal bleeding) at 90 days and three years after the first recorded alarm symptom. For each outcome analyses were implemented separately in a time to event framework. Data were censored if patients died, left the practice, or reached the end of the study period.


RESULTS
We analysed data on first episodes of haematuria (11 108), haemoptysis (4812), dysphagia (5999), or rectal bleeding (15 289). Non-cancer diagnoses were common in patients who presented with alarm symptoms. The proportion diagnosed with either cancer or non-cancer diagnoses generally increased with age. In patients presenting with haematuria, the proportions diagnosed with either cancer or non-cancer diagnoses within 90 days were 17.5% (95% confidence interval 16.4% to 18.6%) in women and 18.3% (17.4% to 19.3%) in men. For the other symptoms the proportions were 25.7% (23.8% to 27.8%) and 24% (22.5% to 25.6%) for haemoptysis, 17.2% (16% to 18.5%) and 22.6% (21% to 24.3%) for dysphagia, and 14.5% (13.7% to 15.3%) and 16.7% (15.8% to 17.5%) for rectal bleeding.


CONCLUSIONS
Clinically relevant diagnoses are made in a high proportion of patients presenting with alarm symptoms. For every four to seven patients evaluated for haematuria, haemoptysis, dysphagia, or rectal bleeding, relevant diagnoses will be identified in one patient within 90 days.
Jones
Roger
R
Department of General Practice and Primary Care, Division of Health and Social Care Research, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London SE11 6SP. roger.jones@kcl.ac.uk
Charlton
Judith
J
Latinovic
Radoslav
R
Gulliford
Martin C
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology*; D005194:Family Practice; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006417:Hematuria / Q000209:etiology*; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D011379:Prognosis; D012002:Rectal Diseases / Q000209:etiology*; D013997:Time Factors; D055815:Young Adult
Fam Pract. 1998 Oct;15(5):398-403
9848423
Thorax. 1999 May;54(5):413-9
10212105
Arch Intern Med. 1991 Dec;151(12):2449-51
1747002
BMJ. 2007 Jun 16;334(7606):1261
17504790
BMJ. 2001 Jun 30;322(7302):1555-6
11431280
Am J Gastroenterol. 2006 Jun;101(6):1200-8
16771937
Br J Gen Pract. 2003 Jan;53(486):31-5
12564274
Arch Intern Med. 1989 Jul;149(7):1666-8
2742442
Popul Trends. 1997 Spring;(87):36-40
9134574
Pharmacotherapy. 2003 May;23(5):686-9
12741446
BMJ. 2007 May 19;334(7602):1040
17493982
Br J Cancer. 2004 Oct 4;91(7):1229-35
15305188
Br J Gen Pract. 2002 Apr;52(477):284-9
11942444
Am J Med. 1989 Mar;86(3):262-6
2919607
Am J Gastroenterol. 2006 Aug;101(8):1900-20; quiz 1943
16928254
N Engl J Med. 2006 Nov 23;355(21):2251-2
17124025
BMJ. 1991 Mar 30;302(6779):766-8
2021768
J Med Educ. 1981 Jan;56(1):75-6
7463440
Eur J Cancer Care (Engl). 2006 Jul;15(3):267-71
16882123
Aust Fam Physician. 1990 May;19(5):733-4, 737, 740-2
2346427
Br J Clin Pharmacol. 2000 Jun;49(6):591-6
10848723
Br J Gen Pract. 2006 Oct;56(531):763-7
17007706
BMJ. 2008 Mar 22;336(7645):651-4
18310262
Br Med J. 1974 Mar 30;1(5908):625-6
4821014
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001961
16235292
Gastroenterology. 2006 Aug;131(2):390-401; quiz 659-60
16890592