Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study
Identifieur interne : 001439 ( Istex/Corpus ); précédent : 001438; suivant : 001440Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study
Auteurs : Roger Jones ; Judith Charlton ; Radoslav Latinovic ; Martin C. GullifordSource :
- BMJ [ 0959-8138 ] ; 2009.
Abstract
Objective To evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care. Design Cohort study using the general practice research database. Setting 128 general practices in the UK contributing data, 1994-2000. Participants 762 325 patients aged 15 or older. Main outcome measures 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. Conclusion 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.
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DOI: 10.1136/bmj.b3094
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study</title><author><name sortKey="Jones, Roger" sort="Jones, Roger" uniqKey="Jones R" first="Roger" last="Jones">Roger Jones</name><affiliation><mods: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</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: roger.jones@kcl.ac.uk</mods:affiliation></affiliation></author><author><name sortKey="Charlton, Judith" sort="Charlton, Judith" uniqKey="Charlton J" first="Judith" last="Charlton">Judith Charlton</name><affiliation><mods:affiliation>Department of Public Health Sciences, 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 SE1 3QD</mods:affiliation></affiliation></author><author><name sortKey="Latinovic, Radoslav" sort="Latinovic, Radoslav" uniqKey="Latinovic R" first="Radoslav" last="Latinovic">Radoslav Latinovic</name><affiliation><mods:affiliation>Department of Public Health Sciences, 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 SE1 3QD</mods:affiliation></affiliation></author><author><name sortKey="Gulliford, Martin C" sort="Gulliford, Martin C" uniqKey="Gulliford M" first="Martin C" last="Gulliford">Martin C. Gulliford</name><affiliation><mods:affiliation>Department of Public Health Sciences, 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 SE1 3QD</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:8EED8563BDF8CADA6337C9C523BD172B5A9E1343</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1136/bmj.b3094</idno><idno type="url">https://api.istex.fr/document/8EED8563BDF8CADA6337C9C523BD172B5A9E1343/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001439</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study</title><author><name sortKey="Jones, Roger" sort="Jones, Roger" uniqKey="Jones R" first="Roger" last="Jones">Roger Jones</name><affiliation><mods: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</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: roger.jones@kcl.ac.uk</mods:affiliation></affiliation></author><author><name sortKey="Charlton, Judith" sort="Charlton, Judith" uniqKey="Charlton J" first="Judith" last="Charlton">Judith Charlton</name><affiliation><mods:affiliation>Department of Public Health Sciences, 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 SE1 3QD</mods:affiliation></affiliation></author><author><name sortKey="Latinovic, Radoslav" sort="Latinovic, Radoslav" uniqKey="Latinovic R" first="Radoslav" last="Latinovic">Radoslav Latinovic</name><affiliation><mods:affiliation>Department of Public Health Sciences, 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 SE1 3QD</mods:affiliation></affiliation></author><author><name sortKey="Gulliford, Martin C" sort="Gulliford, Martin C" uniqKey="Gulliford M" first="Martin C" last="Gulliford">Martin C. Gulliford</name><affiliation><mods:affiliation>Department of Public Health Sciences, 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 SE1 3QD</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2009">2009</date><biblScope unit="volume">339</biblScope></imprint><idno type="ISSN">0959-8138</idno></series><idno type="istex">8EED8563BDF8CADA6337C9C523BD172B5A9E1343</idno><idno type="DOI">10.1136/bmj.b3094</idno><idno type="href">bmj-339-bmj-b3094.pdf</idno><idno type="ArticleID">jonr626663</idno><idno type="PMID">19679615</idno><idno type="local">bmj;339/aug13_2/b3094</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0959-8138</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective To evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care. Design Cohort study using the general practice research database. Setting 128 general practices in the UK contributing data, 1994-2000. Participants 762 325 patients aged 15 or older. Main outcome measures 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. Conclusion 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.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Roger Jones</name><affiliations><json:string>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</json:string><json:string>E-mail: roger.jones@kcl.ac.uk</json:string></affiliations></json:item><json:item><name>Judith Charlton</name><affiliations><json:string>Department of Public Health Sciences, 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 SE1 3QD</json:string></affiliations></json:item><json:item><name>Radoslav Latinovic</name><affiliations><json:string>Department of Public Health Sciences, 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 SE1 3QD</json:string></affiliations></json:item><json:item><name>Martin C Gulliford</name><affiliations><json:string>Department of Public Health Sciences, 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 SE1 3QD</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Urology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Oesophagus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Epidemiologic studies</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>General practice / family medicine</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Urological surgery</value></json:item></subject><articleId><json:string>jonr626663</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective To evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care. Design Cohort study using the general practice research database. Setting 128 general practices in the UK contributing data, 1994-2000. Participants 762 325 patients aged 15 or older. Main outcome measures 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. Conclusion 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.</abstract><qualityIndicators><score>8</score><pdfVersion>1.3</pdfVersion><pdfPageSize>595 x 794 pts</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1785</abstractCharCount><pdfWordCount>6279</pdfWordCount><pdfCharCount>39439</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>265</abstractWordCount></qualityIndicators><title>Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort 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uri="https://api.istex.fr/document/8EED8563BDF8CADA6337C9C523BD172B5A9E1343/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>British Medical Journal Publishing Group</publisher><availability status="free"><p>Open Access</p></availability><date>2009-08-13</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study</title><author xml:id="author-1" corresp="yes"><persName><forename type="first">Roger</forename><surname>Jones</surname></persName><email>roger.jones@kcl.ac.uk</email><note type="biography">Wolfson professor of general practice</note><affiliation>Wolfson professor of general practice</affiliation><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</affiliation></author><author xml:id="author-2"><persName><forename type="first">Judith</forename><surname>Charlton</surname></persName><note type="biography">research assistant</note><affiliation>research assistant</affiliation><affiliation>Department of Public Health Sciences, 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 SE1 3QD</affiliation></author><author xml:id="author-3"><persName><forename type="first">Radoslav</forename><surname>Latinovic</surname></persName><note type="biography">database manager</note><affiliation>database manager</affiliation><affiliation>Department of Public Health Sciences, 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 SE1 3QD</affiliation></author><author xml:id="author-4"><persName><forename type="first">Martin C</forename><surname>Gulliford</surname></persName><note type="biography">professor of public health</note><affiliation>professor of public health</affiliation><affiliation>Department of Public Health Sciences, 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 SE1 3QD</affiliation></author></analytic><monogr><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="pISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2009"></date><biblScope unit="volume">339</biblScope></imprint></monogr><idno type="istex">8EED8563BDF8CADA6337C9C523BD172B5A9E1343</idno><idno type="DOI">10.1136/bmj.b3094</idno><idno type="href">bmj-339-bmj-b3094.pdf</idno><idno type="ArticleID">jonr626663</idno><idno type="PMID">19679615</idno><idno type="local">bmj;339/aug13_2/b3094</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009-08-13</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objective To evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care. Design Cohort study using the general practice research database. Setting 128 general practices in the UK contributing data, 1994-2000. Participants 762 325 patients aged 15 or older. Main outcome measures 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. Conclusion 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.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Urology</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Oesophagus</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Epidemiologic studies</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>General practice / family medicine</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Urological surgery</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-08-13">Created</change><change 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abbrev-type="publisher">BMJ</abbrev-journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jonr626663</article-id><article-id pub-id-type="doi">10.1136/bmj.b3094</article-id><article-id pub-id-type="other">bmj;339/aug13_2/b3094</article-id><article-id pub-id-type="other">bmj;bmj.b3094</article-id><article-id pub-id-type="other">aug13_2</article-id><article-id pub-id-type="pmid">19679615</article-id><article-id pub-id-type="other">bmj.b3094</article-id><article-id pub-id-type="other">bmj.b3094</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Urology</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Oesophagus</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Epidemiologic studies</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>General practice / family medicine</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Urological surgery</subject></subj-group></article-categories><title-group><article-title>Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Jones</surname><given-names>Roger</given-names></name><role>Wolfson professor of general practice</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Charlton</surname><given-names>Judith</given-names></name><role>research assistant</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Latinovic</surname><given-names>Radoslav</given-names></name><role>database manager</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Gulliford</surname><given-names>Martin C</given-names></name><role>professor of public health</role><xref ref-type="aff" rid="aff2">2</xref></contrib><aff id="aff1"><label>1</label>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 </aff><aff id="aff2"><label>2</label>Department of Public Health Sciences, 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 SE1 3QD </aff></contrib-group><author-notes><corresp>Correspondence to: R Jones <email>roger.jones@kcl.ac.uk</email></corresp></author-notes><pub-date pub-type="collection"><year>2009</year></pub-date><pub-date pub-type="ppub"><year>2009</year></pub-date><pub-date pub-type="epub-original"><year>2009</year></pub-date><pub-date pub-type="epub"><day>13</day><month>8</month><year>2009</year></pub-date><volume>339</volume><volume-id pub-id-type="other">339</volume-id><volume-id pub-id-type="other">339</volume-id><elocation-id>b3094</elocation-id><history><date date-type="accepted"><day>31</day><month>March</month><year>2009</year></date></history><permissions><license license-type="open-access"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/</ext-link> and <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/legalcode" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/legalcode</ext-link>.</p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-339-bmj-b3094.pdf"></self-uri><abstract><p><bold>Objective</bold> To evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care.</p><p><bold>Design</bold> Cohort study using the general practice research database.</p><p><bold>Setting</bold> 128 general practices in the UK contributing data, 1994-2000.</p><p><bold>Participants</bold> 762 325 patients aged 15 or older.</p><p><bold>Main outcome measures</bold> 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.</p><p><bold>Results</bold> 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.</p><p><bold>Conclusion</bold> 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.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Roger</namePart><namePart type="family">Jones</namePart><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</affiliation><affiliation>E-mail: roger.jones@kcl.ac.uk</affiliation><description>Wolfson professor of general practice</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Judith</namePart><namePart type="family">Charlton</namePart><affiliation>Department of Public Health Sciences, 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 SE1 3QD</affiliation><description>research assistant</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Radoslav</namePart><namePart type="family">Latinovic</namePart><affiliation>Department of Public Health Sciences, 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 SE1 3QD</affiliation><description>database manager</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Martin C</namePart><namePart type="family">Gulliford</namePart><affiliation>Department of Public Health Sciences, 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 SE1 3QD</affiliation><description>professor of public health</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>Urology</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Oesophagus</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Epidemiologic studies</topic></subject><subject><genre>hwp-journal-coll</genre><topic>General practice / family medicine</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Urological surgery</topic></subject><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2009</dateIssued><dateCreated encoding="w3cdtf">2009-08-13</dateCreated><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Objective To evaluate the predictive value of alarm symptoms for specified non-cancer diagnoses and cancer diagnoses in primary care. Design Cohort study using the general practice research database. Setting 128 general practices in the UK contributing data, 1994-2000. Participants 762 325 patients aged 15 or older. Main outcome measures 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. Conclusion 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.</abstract><relatedItem type="host"><titleInfo><title>BMJ</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0959-8138</identifier><identifier type="eISSN">1468-5833</identifier><identifier type="PublisherID">bmj</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>339</number></detail></part></relatedItem><identifier type="istex">8EED8563BDF8CADA6337C9C523BD172B5A9E1343</identifier><identifier type="DOI">10.1136/bmj.b3094</identifier><identifier type="href">bmj-339-bmj-b3094.pdf</identifier><identifier type="ArticleID">jonr626663</identifier><identifier type="PMID">19679615</identifier><identifier type="local">bmj;339/aug13_2/b3094</identifier><accessCondition type="use and reproduction" contentType="open-access">This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><annexes><json:item><original>true</original><mimetype>image/jpeg</mimetype><extension>jpeg</extension><uri>https://api.istex.fr/document/8EED8563BDF8CADA6337C9C523BD172B5A9E1343/annexes/jpeg</uri></json:item></annexes><enrichments><json:item><type>multicat</type><uri>https://api.istex.fr/document/8EED8563BDF8CADA6337C9C523BD172B5A9E1343/enrichments/multicat</uri></json:item><json:item><type>refBibs</type><uri>https://api.istex.fr/document/8EED8563BDF8CADA6337C9C523BD172B5A9E1343/enrichments/refBibs</uri></json:item></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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