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. 2002 Apr;52(477):284–289.

Patients with new onset haematuria: assessing the discriminant value of clinical information in relation to urological malignancies.

Nicholas Summerton 1, Sara Mann 1, Alan S Rigby 1, Julie Ashley 1, Sarah Palmer 1, John W Hetherington 1
PMCID: PMC1314268  PMID: 11942444

Abstract

BACKGROUND: There is little information available to assist general practitioners (GPs) in deciding which patients with haematuria are likely to have a malignancy. AIM: To derive discriminant functions for specific items or clusters of clinical history information in relation to the categorisation of patients presenting to the 'open access' haematuria clinic in Hull. DESIGN OF STUDY: Recruitment of patients via an 'open-access' haematuria clinic. SETTING: A consecutive series of 363 patients aged between 18 and 80 years who attended the clinic. METHOD: Between February 1999 and October 1999 clinical history information derived from the participating patients was compared with the patients' diagnoses. Diagnoses were established by a combination of cystoscopy and radiological assessments and rechecked against the patient records and the hospital patient administration system two to three months later. RESULTS: A number of individual variables seemed to be particularly helpful in discriminating malignancies. However, when indicants were combined using regression shrinkage techniques, only the following variables were preserved: age, sex, type of haematuria, number of episodes of haematuria, hesitancy, poor urinary stream, smoking history, and history of urinary tract infections. CONCLUSION: It is possible to generate helpful discriminant information to assist GPs in making more appropriate decisions in a difficult area of clinical practice. However, it remains a matter of judgement as to how representative the study population is likely to be compared with all haematuria patients encountered in primary care. We have reasonable confidence in the general applicability of the rules for macroscopic haematuria: however, it seems likely that the prediction rules outlined for microscopic haematuria have their greatest relevance once a patient has been referred by a GP. In developing the work further and testing out the discriminators identified in this study, we propose that a primary care-based project now needs to be undertaken focusing on microscopic haematuria with a particular emphasis on addressing selection biases. In addition, there is a more general need to assess the reliability of all the suggested items of clinical discriminant information.

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Selected References

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  1. Buntinx F., Wauters H. The diagnostic value of macroscopic haematuria in diagnosing urological cancers: a meta-analysis. Fam Pract. 1997 Feb;14(1):63–68. doi: 10.1093/fampra/14.1.63. [DOI] [PubMed] [Google Scholar]
  2. Crichton N. J., Fryer J. G., Spicer C. C. Some points on the use of 'independent Bayes' to diagnose acute abdominal pain. Stat Med. 1987 Dec;6(8):945–959. doi: 10.1002/sim.4780060809. [DOI] [PubMed] [Google Scholar]
  3. Feinstein A. R. Clinical biostatistics. XXXIX. The haze of Bayes, the aerial palaces of decision analysis, and the computerized Ouija board. Clin Pharmacol Ther. 1977 Apr;21(4):482–496. doi: 10.1002/cpt1977214482. [DOI] [PubMed] [Google Scholar]
  4. Fijten G. H., Starmans R., Muris J. W., Schouten H. J., Blijham G. H., Knottnerus J. A. Predictive value of signs and symptoms for colorectal cancer in patients with rectal bleeding in general practice. Fam Pract. 1995 Sep;12(3):279–286. doi: 10.1093/fampra/12.3.279. [DOI] [PubMed] [Google Scholar]
  5. Froom P., Froom J., Ribak J. Asymptomatic microscopic hematuria--is investigation necessary? J Clin Epidemiol. 1997 Nov;50(11):1197–1200. doi: 10.1016/s0895-4356(97)00124-8. [DOI] [PubMed] [Google Scholar]
  6. Hilden J. Statistical diagnosis based on conditional independence does not require it. Comput Biol Med. 1984;14(4):429–435. doi: 10.1016/0010-4825(84)90043-x. [DOI] [PubMed] [Google Scholar]
  7. Knill-Jones R. P. Diagnostic systems as an aid to clinical decision making. Br Med J (Clin Res Ed) 1987 Nov 28;295(6610):1392–1396. doi: 10.1136/bmj.295.6610.1392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. LEE L. W., DAVIS E., Jr Gross urinary hemorrhage: a symptom, not a disease. J Am Med Assoc. 1953 Oct 31;153(9):782–784. doi: 10.1001/jama.1953.02940260006002. [DOI] [PubMed] [Google Scholar]
  9. Lilford R. J., Chard T. Problems and pitfalls of risk assessment in antenatal care. Br J Obstet Gynaecol. 1983 Jun;90(6):507–510. doi: 10.1111/j.1471-0528.1983.tb08956.x. [DOI] [PubMed] [Google Scholar]
  10. Lynch T. H., Waymont B., Dunn J. A., Hughes M. A., Wallace D. M. Rapid diagnostic service for patients with haematuria. Br J Urol. 1994 Feb;73(2):147–151. doi: 10.1111/j.1464-410x.1994.tb07482.x. [DOI] [PubMed] [Google Scholar]
  11. Mommsen S., Aagaard J., Sell A. Presenting symptoms, treatment delay and survival in bladder cancer. Scand J Urol Nephrol. 1983;17(2):163–167. doi: 10.3109/00365598309180162. [DOI] [PubMed] [Google Scholar]
  12. Morton B. A., Teather D., du Boulay G. H. Statistical modelling and diagnostic aids. Med Decis Making. 1984;4(3):339–348. doi: 10.1177/0272989X8400400310. [DOI] [PubMed] [Google Scholar]
  13. Muris J. W., Starmans R., Fijten G. H., Crebolder H. F., Schouten H. J., Knottnerus J. A. Non-acute abdominal complaints in general practice: diagnostic value of signs and symptoms. Br J Gen Pract. 1995 Jun;45(395):313–316. [PMC free article] [PubMed] [Google Scholar]
  14. Newton P., Hannay D. R., Laver R. The presentation and management of female breast symptoms in general practice in Sheffield. Fam Pract. 1999 Aug;16(4):360–365. doi: 10.1093/fampra/16.4.360. [DOI] [PubMed] [Google Scholar]
  15. Rigby A. S. Development of a scoring system to assist in the diagnosis of rheumatoid arthritis. Methods Inf Med. 1991;30(1):23–29. [PubMed] [Google Scholar]
  16. Ritchie C. D., Bevan E. A., Collier S. J. Importance of occult haematuria found at screening. Br Med J (Clin Res Ed) 1986 Mar 8;292(6521):681–683. doi: 10.1136/bmj.292.6521.681. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Spiegelhalter D. J. Statistical methodology for evaluating gastrointestinal symptoms. Clin Gastroenterol. 1985 Jul;14(3):489–515. [PubMed] [Google Scholar]
  18. Summerton N. Diagnosis and general practice. Br J Gen Pract. 2000 Dec;50(461):995–1000. [PMC free article] [PubMed] [Google Scholar]

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