| Title |
Diagnostic Evaluation of Patients Presenting to Primary Care with Rectal Bleeding
|
|---|---|
| Published in |
Journal of General Internal Medicine, January 2018
|
| DOI | 10.1007/s11606-017-4273-x |
| Pubmed ID | |
| Authors |
Sanja Percac-Lima, Lydia E. Pace, Kevin H. Nguyen, Charis N. Crofton, Katharine A. Normandin, Sara J. Singer, Meredith B. Rosenthal, Alyna T. Chien |
| Abstract |
Rectal bleeding is a common, frequently benign problem that can also be an early sign of colorectal cancer. Diagnostic evaluation for rectal bleeding is complex, and clinical practice may deviate from available guidelines. To assess the degree to which primary care physicians document risk factors for colorectal cancer among patients with rectal bleeding and order colonoscopies when indicated, and the likelihood of physicians ordering and patients receiving recommended colonoscopies based on demographic characteristics, visit patterns, and clinical presentations. Cross-sectional study using explicit chart abstraction methods. Three hundred adults, 40-80 years of age, presenting with rectal bleeding to 15 academically affiliated primary care practices between 2012 and 2016. 1) The frequency at which colorectal cancer risk factors were documented in patients' charts, 2) the frequency at which physicians ordered colonoscopies and patients received them, and 3) the odds of ordering and patients receiving recommended colonoscopies based on patient demographic characteristics, visit patterns, and clinical presentations. Risk factors for colorectal cancer were documented between 9% and 66% of the time. Most patients (89%) with rectal bleeding needed a colonoscopy according to a clinical guideline. Physicians placed colonoscopy orders for 74% of these patients, and 56% completed the colonoscopy within a year (36% within 60 days). The odds of physicians ordering recommended colonoscopies were significantly higher in patients aged 50-64 years of age than in those aged 40-50 years (OR = 2.23, 95% CI: 1.04, 4.80), and for patients whose most recent colonoscopy was 5 or more years ago (OR = 4.04, 95% CI: 1.50, 10.83). The odds of physicians ordering and patients receiving recommended colonoscopies were significantly lower for each primary care visit unrelated to rectal bleeding (OR = 0.85, 95% CI: 0.75, 0.96). Diagnostic evaluation of patients presenting to primary care with rectal bleeding may be suboptimal because of inadequate risk factor assessment and prioritization of patients' other concurrent medical problems. |
X Demographics
The data shown below were collected from the profiles of 6 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Ireland | 1 | 17% |
| United Kingdom | 1 | 17% |
| United States | 1 | 17% |
| Unknown | 3 | 50% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Scientists | 3 | 50% |
| Members of the public | 2 | 33% |
| Science communicators (journalists, bloggers, editors) | 1 | 17% |
Mendeley readers
The data shown below were compiled from readership statistics for 48 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 48 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 7 | 15% |
| Researcher | 5 | 10% |
| Other | 4 | 8% |
| Student > Master | 4 | 8% |
| Student > Ph. D. Student | 4 | 8% |
| Other | 8 | 17% |
| Unknown | 16 | 33% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 17 | 35% |
| Nursing and Health Professions | 4 | 8% |
| Arts and Humanities | 2 | 4% |
| Business, Management and Accounting | 1 | 2% |
| Agricultural and Biological Sciences | 1 | 2% |
| Other | 4 | 8% |
| Unknown | 19 | 40% |
Attention Score in Context
This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 February 2018.
All research outputs
#7,592,412
of 23,911,072 outputs
Outputs from Journal of General Internal Medicine
#4,087
of 7,806 outputs
Outputs of similar age
#148,713
of 449,043 outputs
Outputs of similar age from Journal of General Internal Medicine
#79
of 140 outputs
Altmetric has tracked 23,911,072 research outputs across all sources so far. This one has received more attention than most of these and is in the 68th percentile.
So far Altmetric has tracked 7,806 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.8. This one is in the 47th percentile – i.e., 47% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 449,043 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 66% of its contemporaries.
We're also able to compare this research output to 140 others from the same source and published within six weeks on either side of this one. This one is in the 43rd percentile – i.e., 43% of its contemporaries scored the same or lower than it.