Table 1 Summary of the included studies

From: Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

Author, Year Number of patients
Mean age (range)
Sex (♂:♀)
Patient population
Setting
Prior colorectal cancer Reference standard and number or percentage of patients receiving it
Follow-up
Prevalence of symptoms/signs/patient characteristics PLR
Du Toit et al, 2006 265 pt
ND years (45–ND years)♂ND: ♀ND
Pt 45 years with new onset rectal bleeding, irrespective of other symptoms.
Rural practice in England; four doctors; one registrar.
5.7% (15 of 265) Rigid sigmoidoscopy with barium enaema (most patients), flexible sigmoidoscopy, or colonoscopy. (p 69)
Follow-up: unclear
Patient characteristics Age 45–54 years Age 55–64 years Age 65–74 years Age 75 years % Population 19% 28% 24% 29% PLR 0.7 0.2 1.8 1.4
Ellis and Thompson 2005 319 pt
59 years (35–94 years)
♂143: ♀176
Pt 35 years consulting their GP with rectal bleeding
19 GPs in 3 practices in the United Kingdom: 1 market town/rural community; 1 suburban; 1 inner-city
3.4% (11 of 319) -Flexible sigmoidoscopy (219 pt)
-Patient questionnaire (47 pt)
-Flexible sigmoidoscopy & questionnaire (53 pt)
-Barium enaema (37 pt)
-Colonoscopy (24 pt)
Follow-up:18 months
Symptoms/signs/patient characteristics Bleeding and CIBH (n=119) Bleeding and CIBH (loose +/− frequent) (n=83) % Population 37% 26% PLR 2.4 1.3
      Bleeding and no perianal symptoms (n=63) 20% 2.9
      Bleeding CIBH and abdominal pain (n=67) 21% 1.0
      Dark blood (n=31) 10% 2.1
      Age 60 years (n=155) 49% 1.5
      Blood on paper only (n=82) 26% 0.6
      Large volume of blood (n=79) 25% 0.3
      First time rectal bleeding (n=106) 33% 1.2
      Blood mixed with stool (n=33) 10% 0.7
Fijten et al, 1995 269 pt
42 years (18–75 years)
♂118: ♀151
Patients 18 years and 75 years with overt rectal bleeding as a reason for consult or history of recent (<3 month) blood loss visible.
83 GPs in the South of the Netherlands
3.3% (9 of 269) A total of 31% had further investigations initiated by the GP by means of sigmoidoscopy (9%) colon roentenography (9%), proctoscopy (8%), sonography (6%) and colonoscopy (2%). Some patients underwent more than one investigation.
Follow-up: at least 1 year (mean 20 months) Medical records and information of the GP.
Symptoms/signs Blood seen: Mixed with stool only On stool or mixed with stool only Others or combinations % Population 5% 20% 45% PLR 8.0 3.8 0.4
      Abdominal pain 50% 0.7
      Change in bowel habit (more frequently or diarrhoea or variously, but not constipation) 29% 2.9
      Pain at night 19% 0.0
      Decreased appetite 16% 0.7
      Nausea 25% 0.4
      Weight loss 16% 3.0
      Family history of abdominal disease 31% 0.0
      Previous history of rectal bleeding 36% 0.0
      Pale conjunctivae 2% 5.8
      Perianal eczema 6% 6.2
      Rectal palpation (n=208):   
       Haemorrhoid 7% 2.5
       Tumour 0% 1.0
       Abnormal prostate 1% 22.3
      Patient characteristics % Population PLR
      Age 18–29 years 23% 0.0
      Age 30–39 years 26% 0.0
      Age 40–49 years 20% 0.0
      Age 50–59 years 15% 0.7
      Age 60–75 years 15% 7.2
      Male 44% 1.8
      Laboratory test results % Population PLR
      Anaemia (Hb♀ < 7.5 mmol l−1 ♂<8.5 mmol l−1) 5% 6.6
      ESR high (♀>28 mm h−1♂>8.5 mm h−1) 9% 4.2
      ESR high (>30 mm h−1) 4% 8.8
      High white blood cell count (>109 per litre) (n=219) 9% 5.8
      Haemoccult 1 positive out of 3 15% 2.3
Heintze et al, 2005 422 pt
ND years (ND–ND years)
♂199: ♀222
Patients >15 years
94 GPs in Germany
4.0% (17 of 422) Diagnostic work-up: Sonography (52 pt)
Rectoscopy (29 pt)
Sigmoidscopy (26 pt)
Colonoscopy (195 pt)
Treatment by GP (93pt)
Follow-up: Unclear
Symptoms/signs/patient characteristics Male Age <50 years Age 50 years Age 15–24 years % Population 53% 38% 62% 2% PLR 1.3 0.2 1.5 0.0
      Age 25–34 years 11% 0.4
      Age 35–44 years 14% 0.3
      Age 45–54 years 16% 0.5
      Age 55–64 years 28% 1.3
      Age 65–74 years 18% 1.7
      Age 75–84 years 8% 0.5
      Age 85–94 years 2% 8.4
      Weight loss 3% 1.3
      Changed bowel habit 18% 1.2
      Abdominal pain 24% 0.7
      Anaemia 6% 2.4
      Dark red blood 12% 1.1
      Blood mixed with stool 19% 1.9
      Family history of colon carcinoma 7% 3.6
Mant et al, 1989 145 pt
58 years (40–95 years)
♂77: ♀68
Pt 40 years who consulted the GP for rectal bleeding
48 GPs in Australia
11% (16 of 145) -Total colonoscopy (104 pt)
-Endoscopy to at least 30 cm and an air-contrast barium enaema (32 pt)-Investigations not complete, but an obvious source was found, e.g. rectal cancer at proctoscopy. (9 pt)
Follow-up: unclear
Symptoms/signs/patient characteristics Male First-degree relative with CRC (n=143) Abdominal pain (n=144) % Population 53% 14% 30% PLR 0.8 0.9 0.8
      Change in bowel habit (n=143) 39% 1.0
      Feeling of incomplete evacuation of rectum 29% 1.1
      Weight Loss (n=143) 10% 1.3
      Anal itch 25% 0.2
      Pain on defecation 21% 0.6
      Anal protrusion noticed by patient 21% 0.3
      Dark red blood (n=144) 16% 1.7
      Blood mixed with faeces (n=140) 36% 2.2
      Haemorrhoids identified by GP 51% 0.5
Metcalf et al, 1996 99 pt
58 years (40–86 years)
♂42: ♀57
Patients 40 years
17 GPs in Newcastle upon Tyne, England
8.1% (8 of 99) Questionnaire (99pt)
Colonoscopy (98pt)
Barium enaema in any patients whom a satisfactory colonoscopy was not completed. (1pt)
Follow-up: Unclear (Practices participated between 1–9 months)
Symptoms/signs/patient characteristics Dark red blood loss Blood mixed with stool Diarrhoea Associated slime % Population 31% 46% 32% 28% PLR 1.2 1.4 0.9 1.4
      Constipation 39% 0.3
      Change in bowel habit 39% 1.3
      Abdominal pain 42% 0.9
      Weight loss 15% 1.8
Norrelund and Norrelund 1996(1) 208 pt
42 years (18–75 years)
♂97: ♀111
Patients 40 years presenting with a first episode of rectal bleeding
96 GPs from Denmark
15.4% (32 of 208) GPs were asked to arrange either a barium enaema or a colonoscopy at the first consultation.
Follow-up: 32 months
Colorectal cancer microscopically verified or yearly letter to GP
Symptoms/signs/patient characteristics Male Age 40–69 years Age 70–79 years Age 80+ years % Population 47% 68% 25% 7% PLR 1.3 0.3 3.3 2.2
      Weight loss 11% 1.6
      Abdominal pain 23% 1.5
      Change in bowel habits 29% 2.6
      Discomfort 27% 1.3
Norrelund and Norrelund 1996(2) 156 pt
42 years (18–75 years)
♂71: ♀85
Patients 40 years first bleeding episode or change in usual bleeding pattern
112 GPs from Denmark
14.1% (22 of 156) GPs were asked to arrange either a barium enaema or a colonoscopy at the first consultation.
Follow-up: 22 months
CRC microscopically verified or yearly letter to GP
Symptoms/signs/patient characteristics Male Age 40–69 years Age 70–79 years Age 80+ years % Population 46% 72% 21% 7% PLR 1.0 0.7 2.4 0.6
      Weight loss 14% 1.8
      Abdominal pain 27% 2.2
      Change in bowel habits 31% 1.6
      Discomfort 26% 0.9
      New rectal bleeding 69% 0.8
Wauters et al, 2000 386 pt
ND years (ND-ND years)
♂ND: ♀ND
Network of sentinel practices in Belgium 7.0% (27 of 386) Investigations such as endoscopy were not systematically performed. ‘To obtain the number of all new cases of cancer, we sent recall letters to the practices every six months and at the end of the follow-up period.’ (p 998)
Follow-up (clinical): 18–30 months
Symptoms/signs/patient characteristics Age <50 years Age 50–59 years Age 60–69 years Age 70–79 years Age 80 years Pain % Population 37% 15% 18% 17% 13% 9% PLR 0.1 0.2 1.7 3.6 0.8 0.0
      Spasms 29% 0.8
      Weight loss 6% 2.5
      Palpable tumour 5% 6.1
  1. Abbreviations: CIBH=change in bowel habit; ND=no data available. The page numbers refer to the original text of the included studies.