[Prospective study to evaluate diagnostic accuracy in benign anal diseases in primary care]

Abstract

Objective: To analyse the diagnostic performance of the primary care (PC) doctor in benign anal diseases.

Design: Cross-sectional study including patients referred to our clinic from PC with the diagnosis of clinical conditions pertaining to benign anal diseases between 1st June and 31st December 2007. The diagnosis established by the PC doctor was compared with that of 2 medical specialists in general and digestive diseases surgery.

Setting: Department of General Surgery and Digestive Diseases. Castellon General Hospital.

Participants: Patients diagnosed with a benign anal disease in PC and referred to our department.

Measurements: The sensitivity, specificity and kappa index was calculated for each disease.

Results: A total of 105 patients were included. The diagnoses were: 65 haemorrhoids, 13 fissures, 8 fistulas, 7 abscesses, 4 pilonidal cysts, and 8 other diagnoses. A physical examination was carried out on 61 patients and 19 had a rectal examination. In AE, 44 haemorrhoids, 20 fissures, 9 pilonidal cysts were diagnosed and there were 16 other diagnoses. For haemorrhoids the sensitivity was 90.9%, the specificity 59%, and the kappa index was 0.5. For a fistula, it was 43.8%, 98.9% and 0.5, respectively and for a fissure, 15%, 88.2% and 0.04. The physical examination improved all these results.

Conclusions: The diagnostic performance of benign anal diseases in PC is insufficient. A good physical examination and improved training in these diseases could possibly improve these results.

Figura 1

Estudio transversal en el que se evaluó la precisión diagnóstica de los médicos de atención primaria para la enfermedad anal benigna más frecuente, en comparación con la de 2 médicos especialistas en cirugía general y del aparato digestivo.