Table 1

Patient inclusion and exclusion criteria

Patient inclusion criteriaPatient exclusion criteria
Registered at a CPRD GOLD practice that subscribes to data linkagePatients who consulted with the same feature of interest as the index consultation in the year before the index consultation‡
A consultation with a medical code or test result (in the case of iron-deficiency anaemia) corresponding to a feature of interest during 2014 or 2015*
Minimum age of patient at presentationDysphagia – 18
Post-menopausal bleeding – 45†
Iron-deficiency anaemia – 60
Rectal bleeding – 50
Haematuria – 45
Breast lump – 30
Continuous registration at the same general practice from a year before to a year after their first index consultation.‡
  • This table was created by the authors.

  • *There were minor changes in the recommendations for patients presenting with iron-deficiency anaemia and haematuria between the original (2005) and updated (2015) guidance. Therefore, we have restricted analysis to patients where an urgent referral would have been recommended in both sets of guidelines. Specifically for anaemia, inclusion as a first presentation was based on the more stringent test values included in the 2005 NICE guidelines of a haemoglobin level ≤11 g/dL for men and ≤10 g/dL for women, plus a ferritin level <20 ng/mL and/or a mean red cell volume <80 fL, and age restriction of 60 years and over related to the 2015 NICE guidelines. For haematuria, the 2015 NICE guidelines advise referral only if there is no evidence of a urinary tract infection, or if haematuria recurs or persists after successful treatment of a urinary tract infection. As such, the first and/or second consultation where antibiotics were prescribed in the absence of referral were excluded. Third visits within 6 months of the first visit were included regardless of GP treatment and referral decision-making.

  • †Although the guidelines do not specify an age range for post-menopausal bleeding, we exclude patients under the age of 45 years due to the small number in our sample (n=30).

  • ‡With the exception of patients who presented with haematuria, the index consultation was defined for each patient as the first consultation with one or more of the six features based on medical codes for five features, and test results for iron-deficiency anaemia. For some patients presenting with haematuria, the second or third visit was included as their index consultation instead of the first visit, but exclusion criteria were applied to their first visit.

  • CPRD, Clinical Practice Research Datalink; GP, general practitioner; NICE, National Institute for Health and Care Excellence.