Assessment of a Colonoscopy Triage Sheet for Use in a Province-Wide Population-Based Colorectal Screening Program

Background and Aims. A colonoscopy triage sheet (CTS) integrating 6 hierarchical scheduling priorities based on indications for screening, surveillance, or symptoms was designed for colonoscopy referral. We compared CTS priority ratings by referring physicians and endoscopists, assessing yields. Methods. Retrospective study of consecutive patients. Data were collected on demographics, CTS and endoscopist priority ratings, and endoscopic findings. Weighted kappa values measured interrater agreement on priority assignment. Predictors of agreement and lesions were identified using multivariable analysis. Results. Among 1230 patients (60.3 years, 52.5% female), clinically significant lesions included tumors (1.1%), polyps per patient ≥ 10 mm (7.6%), and ileocolitis (4.6%). Moderate agreement was found between referring physician and endoscopist on all 6 priorities (weighted kappa 0.55 (0.51; 0.59)). P4 and P5 ratings predicted increased agreement (range of OR for P4: 2.47-4.57; P5: 1.58-2.93). Predictors of clinically significant findings were male gender (OR 1.44, 1.03-2.03) and P1/P2 priorities that were significantly superior to P3 (OR = 2.14; 1.04-4.43), P4 (OR = 2.90; 1.35-6.23), and P5 (OR = 4.30; 2.08-8.88). Conclusion. Priority-assignment agreement is moderate and highest for less urgent ratings. Predictors of clinically significant findings validate the hierarchal priority scheme. Broader validation and physician education are needed.