Derivation and Validation of a Scoring System to Stratify Risk for XXXX in Asymptomatic Adults: A Cross-sectional Study.

@entity1 @entity1127 @entity5 @entity14 @entity652 @entity1141
BACKGROUND: Several methods are recommended equally strongly for @entity14 screening in average-risk @entity1 . Risk stratification would enable tailoring of screening within this group, with less invasive tests (sigmoidoscopy or occult blood tests) for lower-risk @entity1 and colonoscopy for higher-risk @entity1 . OBJECTIVE: To create a risk index for advanced @entity5 ( @entity14 and @entity652 or serrated @entity1127 >= 1.0 cm, villous histology, or high-grade @entity1141 ) anywhere in the colorectum, using the most common risk factors for @entity14 . DESIGN: Cross-sectional study. SETTING: Multiple endoscopy units, primarily in the Midwest. @entity1 : @entity1 aged 50 to 80 years undergoing initial screening colonoscopy (December 2004 to September 2011). MEASUREMENTS: Derivation and validation of a risk index based on points from regression coefficients for age, sex, waist circumference, cigarette smoking, and family history of @entity14 . RESULTS: Among 2993 @entity1 in the derivation set, prevalence of advanced @entity5 was 9.4%. Risks for advanced @entity5 in @entity1 at very low, low, intermediate, and high risk were 1.92% (95% CI, 0.63% to 4.43%), 4.88% (CI, 3.79% to 6.18%), 9.93% (CI, 8.09% to 12.0%), and 24.9% (CI, 21.1% to 29.1%), respectively (P < 0.001). Sigmoidoscopy to the descending colon in the low-risk groups would have detected 51 of 70 (73% [CI, 61% to 83%]) advanced @entity5 . Among 1467 @entity1 in the validation set, corresponding risks for advanced @entity5 were 1.65% (CI, 0.20% to 5.84%), 3.31% (CI, 2.08% to 4.97%), 10.9% (CI, 8.26% to 14.1%), and 22.3% (CI, 16.9% to 28.5%), respectively (P < 0.001). Sigmoidoscopy would have detected 21 of 24 (87.5% [CI, 68% to 97%]) advanced @entity5 . LIMITATIONS: Split-sample validation; results apply to first-time screening. CONCLUSION: This index stratifies risk for advanced @entity5 among average-risk @entity1 by identifying lower-risk groups for which noncolonoscopy strategies may be effective and efficient and a higher-risk group for which colonoscopy may be preferred. PRIMARY FUNDING SOURCE: National @entity5 Institute, Walther @entity5 Institute, Indiana University Simon @entity5 Center, and Indiana Clinical and Translational Sciences Institute.
