Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study Article Swipe
Peter J. Rimmer
,
Jonathan Cheesbrough
,
Jane Harris
,
Melanie Love
,
Samantha Tull
,
Asif Iqbal
,
Daniel Regan-Komito
,
Rachel Cooney
,
Karl Hazel
,
Naveen Sharma
,
Thomas Dietrich
,
Iain Chapple
,
Mohammad Nabil Quraishi
,
Tariq Iqbal
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1136/flgastro-2023-102523
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1136/flgastro-2023-102523
Objective Diagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for early diagnosis and efficient resource utilisation. Methods A rapid-access pathway was implemented for suspected IBD patients referred outside urgent ‘two-week wait’ criteria. Patients were triaged using symptoms and FCP. A 13-point symptom history was taken prediagnosis and clinical indices, including repeat FCP, collected prospectively. Results Of 767 patients (January 2021–August 2023), 423 were diagnosed with IBD (208 Crohn’s disease (CD), 215 ulcerative colitis (UC)). Most common symptoms in CD were abdominal pain (84%), looser stools (84%) and fatigue (79%) and in UC per-rectal bleeding (94%), urgency (82%) and looser stools (81%). Strongest IBD predictors were blood mixed with stools (CD OR 4.38; 95% CI 2.40–7.98, UC OR 33.68; 15.47–73.33) and weight loss (CD OR 3.39; 2.14–5.38, UC OR 2.33; 1.37–4.00). Repeat FCP testing showed reduction from baseline in non-IBD. Both measurements >100 µg/g (area under the curve (AUC) 0.800) and >200 µg/g (AUC 0.834) collectively predicted IBD. However, a second value ≥220 µg/g considered alone, regardless of the first result, was more accurate (Youden’s index 0.735, AUC 0.923). Modelling symptoms with FCP increased AUC to 0.947. Conclusion Serial FCP measurement prevents unnecessary colonoscopy. Two FCPs >200 µg/g could stream patients direct to colonoscopy, with two >100 µg/g prompting clinic review. A second result ≥220 µg/g was more accurate than dual-result thresholds. Coupling home FCP testing with key symptoms may form the basis of effective self-referral pathways.
Related Topics
Concepts
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1136/flgastro-2023-102523
- https://fg.bmj.com/content/flgastro/early/2024/03/12/flgastro-2023-102523.full.pdf
- OA Status
- hybrid
- Cited By
- 1
- References
- 19
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4392697149
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4392697149Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1136/flgastro-2023-102523Digital Object Identifier
- Title
-
Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception studyWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-03-12Full publication date if available
- Authors
-
Peter J. Rimmer, Jonathan Cheesbrough, Jane Harris, Melanie Love, Samantha Tull, Asif Iqbal, Daniel Regan-Komito, Rachel Cooney, Karl Hazel, Naveen Sharma, Thomas Dietrich, Iain Chapple, Mohammad Nabil Quraishi, Tariq IqbalList of authors in order
- Landing page
-
https://doi.org/10.1136/flgastro-2023-102523Publisher landing page
- PDF URL
-
https://fg.bmj.com/content/flgastro/early/2024/03/12/flgastro-2023-102523.full.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://fg.bmj.com/content/flgastro/early/2024/03/12/flgastro-2023-102523.full.pdfDirect OA link when available
- Concepts
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Medicine, Colonoscopy, Inflammatory bowel disease, Ulcerative colitis, Internal medicine, Calprotectin, Abdominal pain, Gastroenterology, Triage, Area under the curve, Youden's J statistic, Disease, Receiver operating characteristic, Emergency medicine, Cancer, Colorectal cancerTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
1Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 1Per-year citation counts (last 5 years)
- References (count)
-
19Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| primary_location.pdf_url | https://fg.bmj.com/content/flgastro/early/2024/03/12/flgastro-2023-102523.full.pdf |
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| publication_date | 2024-03-12 |
| publication_year | 2024 |
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