title: Urgency of referral and its impact on outcome in patients with colorectal cancer.
abstract: OBJECTIVE
  Primary care referral for patients with bowel symptoms is triaged by general practitioners to urgent or routine based on the clinical suspicion of malignancy. Triage directly influences time to assessment and investigation. This study aimed to establish whether urgency of referral of patients with large bowel malignancy has any effect on management.
  
  
  METHODS
  An analysis was undertaken of all patients with colorectal cancer referred by primary care and discussed at the regional colorectal multi-disciplinary team (MDT) meetings from January 2009 to December 2010. Demographics and tumour data were collated prospectively from MDT records, and operation and investigation reports.
  
  
  RESULTS
  Of 369 primary case referrals with colorectal cancer, 303 (82.1%) were urgent and 66 (17.9%) routine. Patient characteristics (age, sex, American Society of Anesthesiologists grade) and resection rates were similar in both groups and no significant difference in tumour location was observed. The time from referral to diagnosis was significantly longer in the routine group (mean 73.7 days vs 30.2 days; P = 0.001). Dukes stage was less advanced for the routine referral group, (P = 0.002).
  
  
  CONCLUSIONS
  Urgency of referral decreased the time to diagnosis. This did not influence resection rates. Dukes stage was higher for urgent referrals. Long-term follow-up is required to determine any impact on survival.
authors.affiliation: Colorectal Department, Aberdeen Royal Infirmary, Aberdeen, UK. georamsay@gmail.com
authors.forename: G
authors.initials: G
authors.lastname: Ramsay
authors.forename: C
authors.initials: C
authors.lastname: MacKay
authors.forename: S
authors.initials: S
authors.lastname: Nanthakumaran
authors.forename: W L
authors.initials: WL
authors.lastname: Craig
authors.forename: T K
authors.initials: TK
authors.lastname: McAdam
authors.forename: M A
authors.initials: MA
authors.lastname: Loudon
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D012017:Referral and Consultation / Q000145:classification*; D018709:Statistics, Nonparametric; D013997:Time Factors; D014218:Triage