Estudio prospectivo para evaluar la precisión diagnóstica en enfermedad anal benigna en atención primaria

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.