title: Is the "red flag" referral pathway effective in diagnosing colorectal carcinoma?
abstract: BACKGROUND
  In 2000-2004 there were, on average, 93 8 new cases of colorectal cancer (CRC) diagnosed per annum in Northern Ireland, accounting for 13.9% of all cancers. The two week "red flag" referral system aims to detect 90% of patients with CRC for prompt treatment. The aim of this study is to examine the impact of the "red flag" referral system on identification of patients with CRC, time to treatment and stage of disease.
  
  
  METHODS
  A random sample of 200 patients referred via the "red flag" system was identified from the local cancer patient tracker database. Data pertaining to demographics, time to hospital appointment, appropriateness of referral and diagnosis were collected. For patients identified with CRC, the stage of disease and time to first definitive treatment were also documented.
  
  
  RESULTS
  Of the 200 patients, 56% were female. The age range was 27-93 years. Eighty three percent were seen within 14 days of referral. Referrals adhered to the guidelines in 45% of cases. There were 4 pancreatic cancers, 1 endometrial cancer, 1 ovarian cancer and 1 myelodysplasia diagnosed. Three patients were diagnosed with CRC (1.5%). Of these, 1 was palliative and the remaining 2 commenced definitive management within 6 days of decision to treat.
  
  
  CONCLUSIONS
  The "red flag" referral system does not appear to be effective in identifying patients with CRC but did identify patients with other types of cancer. Less than half of the referrals adhered to the guidelines. A review of this system should be undertaken.
authors.affiliation: Dept of Surgery, Ulster Hospital, Upper Newtownards Road, Belfast BT16 1RH, United Kingdom. alisonmccoubrey@mac.com
authors.forename: Alison
authors.initials: A
authors.lastname: McCoubrey
authors.forename: Conor
authors.initials: C
authors.lastname: Warren
authors.forename: Ian
authors.initials: I
authors.lastname: McAllister
authors.forename: Robert
authors.initials: R
authors.lastname: Gilliland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009660:Northern Ireland / Q000453:epidemiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Colorectal cancer; Diagnosis; Guidelines; Referral criteria