"alarm symptoms": timely investigation and diagnosis

A study just published on bmj.com reports that many patients presenting to their doctor with certain alarm symptoms, such as difficulty swallowing or rectal bleeding, may not be receiving opportune diagnosis.

Because of their association with serious disease, certain symptoms are generally regarded as "red flags", such as:

• Haematuria, blood in the urine

• Haemoptysis, coughing up blood

• Dysphagia, difficulty swallowing

• Rectal bleeding

Without delay, clinicians should conduct investigations in order to make an early accurate diagnosis.

The prognostic value of these red flag or alarm symptoms for a diagnosis of cancer has nowadays been recognized. However, their predictive value for non-cancer diagnoses is uncertain. This might also have significant implications for patients' health.

In order to find out more, researchers based at King's College London monitored 762,325 patients presenting to general practice in 1994. They all had first episodes of haematuria, haemoptysis, dysphagia or rectal bleeding.

Each of the alarm symptoms were identified and linked to a list of potentially important diagnoses. These were compared with actual diagnoses recorded at 90 days and three years after the first recorded alarm symptom.

In patients with haematuria, haemoptysis, dysphagia, and rectal bleeding approximately one in five had an associated diagnosis at 90 days.

On the other hand, after three years, over three quarters of patients presenting with rectal bleeding did not have a definite diagnosis. There were comparable figures of about 67 percent for dysphagia, 64 percent for haematuria, and 46 percent for haemoptysis.

The authors calculate approximately that for every four to seven patients evaluated for haematuria, haemoptysis, dysphagia, or rectal bleeding, appropriate diagnoses will be identified in one patient within 90 days.

The researchers underline that in the case of patients with multiple symptoms, this proportion would almost surely have been higher. They advise that patients presenting with these symptoms deserve appropriate investigation for non-cancer diagnoses and potential cancer diagnoses, instead of a strategy of waiting on the alert.

"Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study"

Roger Jones, Wolfson professor of general practice,1Judith Charlton, research assistant, Radoslav Latinovic,database manager,Martin C Gulliford, professor of public health

BMJ 2009;339:b3094


Alarm Symptoms (Video Medical And Professional 2020).

Section Issues On Medicine: Medical practice