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J Clin Epidemiol. 2017 Feb;82:149-157.e8. doi: 10.1016/j.jclinepi.2016.09.014. Epub 2016 Oct 28.

Published diagnostic models safely excluded colorectal cancer in an independent primary care validation study.

Author information

1
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands. Electronic address: s.elias@umcutrecht.nl.
2
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, Utrecht, GA 3508, The Netherlands.
3
Department of Gastroenterology, Gelderse Vallei Hospital, PO Box 9025, Ede, HN 6710, The Netherlands.
4
Department of Gastroenterology, Atrium Medical Center, PO Box 4446, Heerlen, CX 6401, The Netherlands.
5
Department of Gastroenterology, Orbis Medical Center, PO Box 5500, Sittard-Geleen, MB 6130, The Netherlands.
6
Department of General Practice, Care and Public Health Research Institute (Caphri), Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands.

Abstract

OBJECTIVE:

To validate published diagnostic models for their ability to safely reduce unnecessary endoscopy referrals in primary care patients suspected of significant colorectal disease.

STUDY DESIGN AND SETTING:

Following a systematic literature search, we independently validated the identified diagnostic models in a cross-sectional study of 810 Dutch primary care patients with persistent lower abdominal complaints referred for endoscopy. We estimated diagnostic accuracy measures for colorectal cancer (N = 37) and significant colorectal disease (N = 141; including colorectal cancer, inflammatory bowel disease, diverticulitis, or >1-cm adenomas).

RESULTS:

We evaluated 18 models-12 specific for colorectal cancer-, of which most were able to safely rule out colorectal cancer: the best model (National Institute for Health and Care Excellence-1) prevented 59% of referrals (95% confidence interval [CI]: 56-63%), with 96% sensitivity (95% CI: 83-100%), 100% negative predictive value (NPV; 95% CI: 99-100%), and an area under the receiver operating characteristics curve (AUC) of 0.86 (95% CI: 0.80-0.92). The models performed less for significant colorectal disease: the best model (Brazer) prevented 23% of referrals (95% CI: 20-26%), with 95% sensitivity (95% CI: 90-98%), 96% NPV (95% CI: 92-98%), and an AUC of 0.73 (95% CI: 0.69-0.78).

CONCLUSION:

Most models safely excluded colorectal cancer in many primary care patients with lower gastrointestinal complaints referred for endoscopy. Models performed less well for significant colorectal disease.

KEYWORDS:

Colorectal cancer; Diagnosis; Primary care; Significant colorectal disease; Systematic review; Validation

PMID:
27989951
DOI:
10.1016/j.jclinepi.2016.09.014
[Indexed for MEDLINE]

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