title: Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study.
abstract: 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.
authors.affiliation: 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
authors.forename: Roger
authors.initials: R
authors.lastname: Jones
authors.forename: Judith
authors.initials: J
authors.lastname: Charlton
authors.forename: Radoslav
authors.initials: R
authors.lastname: Latinovic
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: 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
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