BACKGROUND Many patients present in primary care with lower bowel symptoms, but significant bowel disease (SBD), comprising colorectal cancer (CRC), advanced adenoma (AA), or inflammatory bowel disease (IBD), is uncommon. Quantitative faecal immunochemical tests for haemoglobin (FIT), which examine faecal haemoglobin concentrations (f-Hb), assist in deciding who would benefit from colonoscopy. Incorporation of additional variables in an individual risk-score might improve this approach. We investigated if the published f-Hb, age and sex test score (FAST score) added value. METHODS Data from the first year of routine use of FIT in primary care in one NHS Board in Scotland were examined: f-Hb was estimated using one HM-JACKarc FIT system (Kyowa Medex Co., Ltd., Tokyo, Japan) with a cut-off for positivity ≥10 μg Hb/g faeces. 5660 specimens were received for analysis in the first year. 4072 patients were referred to secondary care: 2881 (70.6%) of these had returned a FIT specimen. Of those referred, 1447 had colonoscopy data as well as the f-Hb result (group A): 2521 patients, also with f-Hb, were not immediately referred (group B). The FAST score was assessed in both groups. RESULTS 1196 (41.7%) of patients who returned a specimen for FIT analysis had f-Hb ≥10 μg Hb/g faeces. In group A, 252 of 296 (85.1%) with SBD had f-Hb > 10 μg Hb/g faeces, as did 528 of 1151 (45.8%) without SBD. Using a FAST score > 2.12, which gives high clinical sensitivity for CRC, only 1143 would have been referred for colonoscopy (21.0% reduction in demand): 286 of 296 (96.6%) with SBD had a positive FAST score, as did 857 of 1151 (74.5%) without SBD. However, one CRC, five AA and four IBD would have been missed. In group B, although 95.2% had f-Hb < 10 μg Hb/g faeces, 1371 (53.7%) had FAST score ≥ 2.12: clinical rationale led to only 122 of group B completing subsequent bowel investigations: a FAST score > 2.12 was found in 13 of 15 (86.7%) with SBD. CONCLUSIONS The performance characteristics of the FAST score did not seem to enhance the utility of f-Hb alone. Locally-derived formulae might confer desired benefits.

中文翻译：

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评估低肠症状患者的粪便血红蛋白，年龄和性别测试（FAST）得分的评估：一项观察性研究。

背景技术许多初级保健患者的肠道症状较低，但包括结肠直肠癌（CRC），晚期腺瘤（AA）或炎性肠病（IBD）在内的严重肠病（SBD）并不常见。粪便血红蛋白（FIT）的定量粪便免疫化学测试可检查粪便血红蛋白浓度（f-Hb），有助于确定谁将从结肠镜检查中受益。在个人风险评分中加入其他变量可能会改善此方法。我们调查了已发表的f-Hb，年龄和性别测验分数（FAST分数）是否增加了价值。方法回顾了苏格兰一个NHS委员会在初级保健中常规使用FIT第一年的数据：使用一台HM-JACKarc FIT系统（Kyowa Medex Co.，Ltd.，东京，日本）估算了f-Hb。阳性≥10μgHb / g粪便的临界值。第一年收到5660个样本进行分析。4072名患者被转诊至二级保健：其中2881名（70.6％）返回了FIT标本。在转诊的那些患者中，有1447例具有结肠镜检查数据以及f-Hb结果（A组）：2521例也患有f-Hb的患者未立即转诊（B组）。两组均评估了FAST评分。结果1196名（41.7％）的患者返回样本进行FIT分析时，其f-Hb≥10μgHb / g粪便。在A组中，有SBD的296名中的252名（85.1％）的f-Hb粪便> 10μgHb / g粪便，无SBD的1151名中的528名（45.8％）。如果FAST得分> 2.12，这对CRC具有很高的临床敏感性，那么结肠镜检查仅需要转诊1143例（需求减少21.0％）：296例SBD患者中的286例（96.6％）的FAST评分为阳性，而857例中的没有SBD的1151（74.5％）。但是，一个CRC 将会错过5个AA和4个IBD。在B组中，尽管95.2％的f-Hb <10μgHb / g粪便，但1371（53.7％）的FAST评分≥2.12：临床依据仅导致B组中的122个人完成了随后的肠道检查：FAST评分> 2.12为发现15的13中有SBD（86.7％）。结论FAST评分的表现特征似乎并未单独增强f-Hb的效用。本地派生的公式可能会带来预期的好处。