Abstract：
OBJECTIVE: Since December 2015, a faecal immunochemical test (FIT) has been provided to primary care in NHS Tayside as an adjunct to clinical acumen in the assessment of new-onset bowel symptoms. The aim of this work was to assess the impact of this approach on time to diagnosis of colorectal cancer (CRC).
METHODS: NHS Tayside Cancer audit data from January 2013 to December 2019 were reviewed to identify all CRC patients diagnosed via the primary-care referral pathway for a period before and after the introduction of FIT. Their electronic patient records were accessed and date of referral and any contemporaneous FIT and full blood count (FBC) result were recorded. Time from referral to diagnosis of CRC was calculated for each patient and compared between subgroups.
RESULTS: The study cohort consisted of 959 patients: 378 and 581 from the time periods before and after the introduction of FIT, respectively. The median time to diagnosis before FIT was 30 days [interquartile range (IQR) 16-57 days] versus 25 days (IQR 14-47 days) following the introduction of FIT (p = 0.006). Following the introduction of FIT, patients who completed a FIT had a median of time to diagnosis of 23 days (IQR 14-43 days) compared with 30 days (IQR 16-62 days) for patients not completing a FIT (p = 0.019). FBC results were available for 97.5% of FIT patients to aid safety-netting of patients with a low or undetectable faecal haemoglobin concentration.
CONCLUSIONS: The introduction of FIT-based triage of new bowel symptoms in primary care as an adjunct to clinical acumen is associated with a reduced time to CRC diagnosis.
METHODS: NHS Tayside Cancer audit data from January 2013 to December 2019 were reviewed to identify all CRC patients diagnosed via the primary-care referral pathway for a period before and after the introduction of FIT. Their electronic patient records were accessed and date of referral and any contemporaneous FIT and full blood count (FBC) result were recorded. Time from referral to diagnosis of CRC was calculated for each patient and compared between subgroups.
RESULTS: The study cohort consisted of 959 patients: 378 and 581 from the time periods before and after the introduction of FIT, respectively. The median time to diagnosis before FIT was 30 days [interquartile range (IQR) 16-57 days] versus 25 days (IQR 14-47 days) following the introduction of FIT (p = 0.006). Following the introduction of FIT, patients who completed a FIT had a median of time to diagnosis of 23 days (IQR 14-43 days) compared with 30 days (IQR 16-62 days) for patients not completing a FIT (p = 0.019). FBC results were available for 97.5% of FIT patients to aid safety-netting of patients with a low or undetectable faecal haemoglobin concentration.
CONCLUSIONS: The introduction of FIT-based triage of new bowel symptoms in primary care as an adjunct to clinical acumen is associated with a reduced time to CRC diagnosis.
摘要：
目的：自2015年12月以来，已向NHSTayside的初级保健提供了粪便免疫化学测试（FIT），作为评估新发肠道症状的临床敏锐性的辅助手段。这项工作的目的是评估这种方法对结直肠癌（CRC）诊断时间的影响。
方法：对2013年1月至2019年12月的NHSTayside癌症审计数据进行了审查，以确定在引入FIT之前和之后通过初级保健转诊途径诊断的所有CRC患者。访问了他们的电子患者记录，并记录了转诊日期以及任何同期的FIT和全血计数（FBC）结果。计算每位患者从转诊到诊断CRC的时间，并在亚组之间进行比较。
结果：研究队列由959名患者组成：引入FIT前后的378名和581名患者，分别。FIT前的中位诊断时间为30天[四分位距（IQR）16-57天]，而引入FIT后为25天（IQR14-47天）（p=0.006）。在介绍FIT之后，完成FIT的患者的中位诊断时间为23天(IQR14~43天),而未完成FIT的患者的中位诊断时间为30天(IQR16~62天)(p=0.019).97.5％的FIT患者可获得FBC结果，以帮助粪便血红蛋白浓度低或无法检测到的患者的安全网。
结论：在初级护理中引入基于FIT的新肠道症状分类作为临床诊断的辅助手段与减少CRC诊断时间相关。
方法：对2013年1月至2019年12月的NHSTayside癌症审计数据进行了审查，以确定在引入FIT之前和之后通过初级保健转诊途径诊断的所有CRC患者。访问了他们的电子患者记录，并记录了转诊日期以及任何同期的FIT和全血计数（FBC）结果。计算每位患者从转诊到诊断CRC的时间，并在亚组之间进行比较。
结果：研究队列由959名患者组成：引入FIT前后的378名和581名患者，分别。FIT前的中位诊断时间为30天[四分位距（IQR）16-57天]，而引入FIT后为25天（IQR14-47天）（p=0.006）。在介绍FIT之后，完成FIT的患者的中位诊断时间为23天(IQR14~43天),而未完成FIT的患者的中位诊断时间为30天(IQR16~62天)(p=0.019).97.5％的FIT患者可获得FBC结果，以帮助粪便血红蛋白浓度低或无法检测到的患者的安全网。
结论：在初级护理中引入基于FIT的新肠道症状分类作为临床诊断的辅助手段与减少CRC诊断时间相关。
