{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T18:19:37Z","timestamp":1772907577391,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,11,3]],"date-time":"2016-11-03T00:00:00Z","timestamp":1478131200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000149","name":"Canadian Association of Gastroenterology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000149","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Clinicians are advised to refer patients with lower gastrointestinal (<jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content>) alarm features for urgent colonoscopy to exclude colorectal cancer (<jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content>). However, the utility of alarm features is debated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess whether performance of alarm features is improved by using a symptom frequency threshold to trigger referral, or by combining them into composite variables, including minimum age thresholds, as recommended by the National Institute for Health and Care Excellence (<jats:styled-content style=\"fixed-case\">NICE<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected data prospectively from 1981 consecutive adults with lower <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> symptoms. Assessors were blinded to symptom status. The reference standard to define <jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content> was histopathological confirmation of adenocarcinoma in biopsy specimens from a malignant\u2010looking colorectal lesion. Controls were patients without <jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content>. Sensitivity, specificity, positive predictive values (<jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>s) and negative predictive values were calculated for individual alarm features, as well as combinations of these.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In identifying 47 (2.4%) patients with <jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content>, individual alarm features had sensitivities ranging from 11.1% (family history of <jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content>) to 66.0% (loose stools), and specificities from 30.5% (loose stools) to 75.6% (family history of <jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content>). Using higher symptom frequency thresholds improved specificity, but to the detriment of sensitivity. <jats:styled-content style=\"fixed-case\">NICE<\/jats:styled-content> referral criteria also had higher specificities and lower sensitivity, with <jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>s above 4.8%. More than 80% of those with <jats:styled-content style=\"fixed-case\">CRC<\/jats:styled-content> met at least one of the <jats:styled-content style=\"fixed-case\">NICE<\/jats:styled-content> referral criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using higher symptom frequency thresholds for alarm features improved specificity, but sensitivity was low. <jats:styled-content style=\"fixed-case\">NICE<\/jats:styled-content> referral criteria had <jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>s above 4.8%, but sensitivities ranged from 2.2% to 32.6%, meaning many cancers would be missed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13846","type":"journal-article","created":{"date-parts":[[2016,11,3]],"date-time":"2016-11-03T06:57:44Z","timestamp":1478156264000},"page":"91-99","source":"Crossref","is-referenced-by-count":12,"title":["Poor predictive value of lower gastrointestinal alarm features in the diagnosis of colorectal cancer in 1981 patients in secondary care"],"prefix":"10.1111","volume":"45","author":[{"given":"S. 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