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Validity of gout diagnosis in Swedish primary and secondary care - a validation study

Artikel i vetenskaplig tidskrift
Författare Mats Dehlin
Kalliopi Stasinopoulou
Lennart T. H. Jacobsson
Publicerad i Bmc Musculoskeletal Disorders
Volym 16
Nummer/häfte 149
ISSN 1471-2474
Publiceringsår 2015
Publicerad vid Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning
Språk en
Länkar dx.doi.org/10.1186/s12891-015-0614-...
Ämnesord Gout, Classification criteria, Validity of diagnosis, CLASSIFICATION CRITERIA, PREDICTIVE-VALUE, SYNOVIAL-FLUID, POPULATION, PREVALENCE, HYPERURICEMIA, ARTHRITIS, RECOMMENDATIONS, MANAGEMENT, DATABASE, Orthopedics, Rheumatology
Ämneskategorier Klinisk laboratoriemedicin, Klinisk medicin

Sammanfattning

Background: The diagnostic golden standard for gout is to detect monosodium urate (MSU) crystals in synovial fluid. While some gout classification criteria include this variable, most gout diagnoses are based on clinical features. This discrepancy between clinical practice and classification criteria can hinder gout epidemiological studies. Here, the objective was to validate gout diagnoses (International Classification of Diseases (ICD)-10 gout codes) in primary and secondary care relative to five classification criteria (Rome, New York, ARA, Mexico, and Netherlands). The frequency with which MSU crystal identification was used to establish gout diagnosis was also determined. Methods: In total, 394 patients with >= 1 ICD-10 gout diagnosis between 2009 and 2013 were identified from the medical records of two primary care centers (n = 262) and one secondary care center (n = 132) in Gothenburg, Sweden. Medical records were assessed for all classification criteria. Results: Primary care patients met criteria cutoffs more frequently when >= 2 gout diagnoses were made. Even then, few primary care patients met the Rome and New York cutoffs (19 % and 8 %, respectively). The ARA, Mexico, and Netherlands cutoffs were met more frequently by primary care patients with >= 2 gout diagnoses (54 %, 81 %, and 80 %, respectively). Mexico and Netherlands cutoffs were met more frequently by the rheumatology department patients (80 % and 71 %, respectively), even when patients with only 1 gout diagnosis were included. Analysis of MSU crystals served to establish gout diagnoses in only 27 % of rheumatology department and 2 % of primary care cases. Conclusions: If a patient was deemed to have gout at >= 2 primary care center or >= 1 rheumatology-center visits according to an ICD-10 gout code, the positive predictive value of this variable in relation with the Mexico and Netherlands classification criteria was >= 80 % for both primary care and rheumatology care settings in Sweden. MSU crystal identification was rarely used to establish gout diagnosis.

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