Table 3.

Clinical features of CRC: Summary of findings. Empty cells indicate that the study did not examine the sign or symptom.

STUDYIDARBRB AND MALERB AND FEMALERB AND ≥50 OR ≥55 YRB AND ≥60 OR ≥65 YRB AND ≥70 OR ≥ 75 YDARK RBRB MIXED WITH STOOLRB AND NO PERIANAL SYMPTOMSRB AND ABD PAINRB AND WT LOSSRB AND CBHCBH OR DIARRHEA*WT LOSSABD PAIN
Primary studies
PPV, % (95% CI)
  • Barwick et al,13 20041116 (9–28)5 (2–12)6.9 (14–24)57
  • Chohan et al,28 200534 (21–50)1814 (9.5–19)
  • Du Toit et al,29 20065.7 (3.4–9.2)6.1 (3.6–10)8.6 (5–15)7.9 (3.6–16)
  • Ellis and Thompson,14 20053.4 (3.6–16)5.2 (2.6–10)9.7 (3.2–26)3.0 (0.4–19)11 (5.4–22)9.2 (4.7–15.9)
  • Fitjen et al,30 19953.3 (1.7–6.3)5.9 (2.9–12)1.0 (0.3–5.1)20 (10–35)14 (3.6–43)2.2 (0.5–6.4)9.5 (2.7–22.6)
  • Flashman et al,31 200410.9 (5–22)10.6 (6.7–16)
  • Hamilton et al,17 20052.4 (1.9–3.2)3.1 (1.9–5.3)4.70.9* (0.7–1.1)1.2 (0.9–1.6)1.1 (0.9–1.3)
  • Heintze et al,18 20054.0 (2.5–6.4)5.6 (3.4–9.1)
  • Helfand et al,32 19976.5 (3.8–11)
  • Jones et al,21 20072.2 (2.0–2.5)2.4 (2.1–2.8)2.0 (1.7–2.3)
  • Mant et al,33 198910 (6.3–16)9.1 (4.4–18)13 (7–24)17 (6.7–38)21 (11–36)9.3 (2.6–22.1)14.3 (1.8–42.8)10.7 (4.0–21.9)
  • Metcalf et al,34 19968.1 (4.1–15)9.7 (3.2–26)11 (4.6–24)7.1 (1.5–19.5)13.3 (1.7–40.5)10.3 (2.9–24.2)
  • Muris et al,35 19930.5 (0.1–1.5)
  • Nørrelund and Nørrelund,36 199614 (11–19)17 (12–24)13 (9–18)3123 (16–33)22.7 (7.8–45.4)27 (19–36)
  • Panzuto et al,37 200340.6 (28.9–53.1)16 (10–24)12 (6.4–21)35.7 (9.3–18.6)13.5 (9.3–18.7)
  • Parker et al,39 20072.2 (2.1–2.4)4.0 (3.7–4.3)4.6 (4.2–5.1)4.9 (4.3–5.6)
  • Robertson et al,24 20063.6 (2.4–5.5)4.8 (2.8–8)2.7 (1.4–5.1)5.7 (3.7–8.7)7.5 (3.8–14)7.4 (3.9–14)5.4 (3.4–8.5)1.7 (0.5–4.4)4.8 (1.0–13.5)
  • Sánchez et al,40 20054.89.5
  • Steine et al,41 19945.9 (3.7–9.3)3.0 (2.1–4.5)4.8 (3–7.6)2.1 (1.4–3.0)
  • Stellon and Kenwright,42 19977.7
  • Wauters et al,43 20007.0 (4.6–10)11 (7–15)13 (9–19)15 (9–22)16 (4.5–36)
  • Yates et al,26 20048.6 (6.1–11.6)
Median PPV (95% CI) across primary studies115.37.53.95.98.67.99.71110.85.11310.57.54.92.1
Meta-analyses
Pooled PPV, % (95% CI)
  • Astin et al,12 20119.7 (3.5–26.8)8.1 (6.0–10.8)7.6 (3.0–19.2)13.4 (8.2–21.9)11.8 (6.8–20.4)3.3 (0.7–15.7)
  • Jellema et al,19 201013 (11–34)7 (5–12)10 (7–13)9 (8–10)13 (8–31)14 (9–21)6 (4–10)5 (0–23)9 (5–23)9 (5–50)
  • Shapley et al,25 20104.6 (3.7–5.5)5.5 (3.9–7.2)
Pooled PLR (95% CI)
  • Astin et al,12 20115.3 (1.7–17.1)1.0 (0.6–1.7)1.9 (1.3–2.8)1.8 (1.3–2.5)2.4 (1.6–3.8)3.5 (2.1–5.8)2.5 (1.1–5.6)
  • Ford et al,15 20081.4 (0.8–2.7)1.3 (1.2–1.5)3.8 (2.6–5.6)1.3 (1.1–1.6)2.0 (1.3–3.1)
  • Olde Bekkink et al,23 20103.7 (1.3–10.4)1.2 (1.0–1.5)2.8 (2.0–3.9)1.4 (0.6–3.3)1.9 (0.8–5.5)0.9 (0.2–1.6)1.9 (1.0–3.1)1.9 (0.5–3.6)
Pooled sensitivity (95% CI)
  • Astin et al,12 201117 (16–18)33 (24–43)19 (12–28)58 (49–67.3)11 (11–12)31 (30–32)
  • Ford et al,15 200817 (5.5–33)64 (55–73)15 (3–34)41 (23–60)22 (14–31)
  • Jellema et al,19 2010§13 (11–34)62 (44–78)91 (86–96)83 (73–93)50 (36–63)35 (25–41)51 (9–77)35 (0–40)20 (13–44)52 (10–100)
  • Olde Bekkink et al,23 201017 (5–35)58 (48–67)66 (45–83)22 (13–34)40 (4–93)25 (4–62)17 (6–37)62 (18–94)
Pooled specificity (95% CI)
  • Astin et al,12 201198 (98–99)63 (60–65)89 (87–90)63 (60–65)96 (96–96)91 (91–92)
  • Ford et al,15 200890 (87–92)52 (42–63)96 (93–98)69 (58–78)89 (81–95)
  • Jellema et al,19 201092 (92–94)55 (46–57)36 (39–46)55 (52–88)79 (72–83)85 (69–87)71 (49–95)59 (49–91)89 (85–94)61 (55–93)
  • Olde Bekkink et al,23 201095 (93–96)52 (48–56)76 (68–83)84 (69–93)81 (23–98)73 (52–89)91 (83–96)68 (53–80)
  • ABD—abdominal, CBH—change in bowel habits, CRC—colorectal cancer, Hb—hemoglobin, IDA—iron deficiency anemia, PLR—positive likelihood ratio, PPV—positive predictive value, RB—rectal bleeding, WT—weight.

  • * Values for diarrhea were used when data on CBH were not available.

  • Definitions of anemia: Barwick et al13 and Chohan et al28 used IDA and Hb < 100 g/L; Flashman et al31 used IDA and Hb < 110 g/L for men and Hb < 100 g/L for women; Hamilton et al17 used Hb < 99 g/L; Panzuto et al37 used IDA and Hb < 140 g/L for men and Hb < 120 g/L for women; Yates et al26 used IDA and Hb < 120 g/L for men and < 110 g/L for women; Olde Bekkink et al23 used Hb < 133 g/L for men and Hb < 120 g/L for women.

  • Where data are not homogeneous, median and range are provided.

  • § Median and range are provided for all.