The National Health Service and Department of Health in the United Kingdom have developed criteria to help general practitioners triage patients with bowel complaints. These can help separate high risk from low risk patients, allowing more efficient use of resources.
|
Clinical Finding |
Age of Patient |
Risk |
|
rectal bleeding with a change in bowel habits with looser stools or increased frequency of defecation persistent for 6 weeks |
all ages |
high |
|
change in bowel habits with looser stools or increased frequency of defecation without rectal bleeding and persistent for 6 weeks |
>= 60 years of age |
high |
|
rectal bleeding persistently without anal symptoms |
>= 60 years of age |
high |
|
palpable right sided abdominal mass |
all ages |
high |
|
palpable rectal (not pelvic) mass |
all ages |
high |
|
unexplained iron deficiency anemia in a man with hemoglobin < 11 g/dL |
all ages |
high |
|
unexplained iron deficiency anemia in a woman with hemoglobin < 10 g/dL |
post-menopausal |
high |
|
Clinical Finding - no iron deficiency anemia, no palpable rectal or abdominal mass with: |
Age of Patient |
Risk |
|
rectal bleeding with anal symptoms and no persistent change in bowel habits |
all ages |
low |
|
rectal bleeding with an obvious external cause (anal fissure, thrombosed or prolapse hemorrhoid, rectal prolapse) |
all ages |
low |
|
change in bowel habits without rectal bleeding |
< 60 years of age |
low |
|
transient change in bowel habits, particularly harder or decreased frequency of defecation |
all ages |
low |
|
abdominal pain as a single symptom without signs and symptoms of intestinal obstruction |
all ages |
low |
where:
• Anal symptoms include soreness, discomfort, itching, lumps, prolapse and/or pain.
• I included the presence of bowel obstruction as a reason for rapid evaluation.
A patient is referred for rapid assessment if:
(1) high risk symptoms persist for > 6 weeks
(2) low risk symptoms are followed by high risk symptoms over the next 3 months
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
