Abstract
BackgroundAnkylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.MethodsNested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms.We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis.ResultsSeveral new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 12.7, 95% CI 4.7 to 34.6); the occurrence of axial pain with and tendon symptoms within the same year (OR 21.7, 95% CI 2.6 to 181.5); and the co-occurrence (within 30 days) of axial pain and a prescription for nonsteroidal anti-inflammatory drug (OR 10.4, 95%CI 4.9 to 22.1). Coded episodes of axial pain increased steadily over the 3 years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis.ConclusionsWe identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.
Highlights
Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis
Data source We analysed data from the Practice Team Information (PTI) database, a subset of the Primary Care Clinical Informatics Unit Research database held by the University of Aberdeen
The PTI database is comprised of pseudonymised electronic health records which were collected between 1996 and 2010 from approximately 224,000 patients registered with a primary care physician in Scotland
Summary
Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. As with other conditions in which a long period between first consultation and diagnosis is often seen, symptoms of AS (such as spinal pain, stiffness and fatigue) are both nonspecific and frequently occuring [2, 3]. For instance the association in time between back pain and prescription of non-steroidal antiinflammatory drugs (NSAID) may suggest inflammatory back pain (which often responds well to NSAIDs) While such knowledge-derived features [9] are not immediately present in electronic records, they can be constructed [10, 11]. One very recent study has used machine learning based on single items in a clinical care database but still found only low predictive values [12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
