Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

Objective To estimate the test accuracy of faecal calprotectin (FC) for inflammatory bowel disease (IBD) in the primary care setting using routine electronic health records.Design Retrospective cohort test accuracy study.Setting UK primary care.Participants 5970 patients (≥18 years) without a previo...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Ronan Ryan, Karoline Freeman, Brian H Willis, Aileen Clarke
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/f8bee55622b14072b6fe4e8f6c32081c
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:f8bee55622b14072b6fe4e8f6c32081c
record_format	dspace
spelling	oai:doaj.org-article:f8bee55622b14072b6fe4e8f6c32081c2021-11-10T21:30:07ZTest accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data10.1136/bmjopen-2020-0441772044-6055https://doaj.org/article/f8bee55622b14072b6fe4e8f6c32081c2021-02-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/2/e044177.fullhttps://doaj.org/toc/2044-6055Objective To estimate the test accuracy of faecal calprotectin (FC) for inflammatory bowel disease (IBD) in the primary care setting using routine electronic health records.Design Retrospective cohort test accuracy study.Setting UK primary care.Participants 5970 patients (≥18 years) without a previous IBD diagnosis and with a first FC test between 1 January 2006 and 31 December 2016. We excluded multiple tests and tests without numeric results in units of µg/g.Intervention FC testing for the diagnosis of IBD. Disease status was confirmed by a recorded diagnostic code and/or a drug code of an IBD-specific medication at three time points after the FC test date.Main outcome measures Sensitivity, specificity, and positive and negative predictive values for the differential of IBD versus non-IBD and IBD versus irritable bowel syndrome (IBS) at the 50 and 100 µg/g thresholds.Results 5970 patients met the inclusion criteria and had at least 6 months of follow-up data after FC testing. 1897 had an IBS diagnosis, 208 had an IBD diagnosis, 31 had a colorectal cancer diagnosis, 80 had more than one diagnosis and 3754 had no subsequent diagnosis. Sensitivity, specificity, and positive and negative predictive values were 92.9% (88.6% to 95.6%), 61.5% (60.2% to 62.7%), 8.1% (7.1% to 9.2%) and 99.6% (99.3% to 99.7%), respectively, at the threshold of 50 µg/g. Raising the threshold to 100 µg/g missed less than 7% additional IBD cases. Longer follow-up had no effect on test accuracy. Overall, uncertainty was greater for specificity than sensitivity. General practitioners’ (GPs’) referral decisions did not follow the anticipated clinical pathways in national guidance.Conclusions GPs can be confident in excluding IBD on the basis of a negative FC test in a population with low pretest risk but should interpret a positive test with caution. The applicability of national guidance to general practice needs to be improved.Ronan RyanKaroline FreemanBrian H WillisAileen ClarkeBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 2 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Ronan Ryan Karoline Freeman Brian H Willis Aileen Clarke Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data
description	Objective To estimate the test accuracy of faecal calprotectin (FC) for inflammatory bowel disease (IBD) in the primary care setting using routine electronic health records.Design Retrospective cohort test accuracy study.Setting UK primary care.Participants 5970 patients (≥18 years) without a previous IBD diagnosis and with a first FC test between 1 January 2006 and 31 December 2016. We excluded multiple tests and tests without numeric results in units of µg/g.Intervention FC testing for the diagnosis of IBD. Disease status was confirmed by a recorded diagnostic code and/or a drug code of an IBD-specific medication at three time points after the FC test date.Main outcome measures Sensitivity, specificity, and positive and negative predictive values for the differential of IBD versus non-IBD and IBD versus irritable bowel syndrome (IBS) at the 50 and 100 µg/g thresholds.Results 5970 patients met the inclusion criteria and had at least 6 months of follow-up data after FC testing. 1897 had an IBS diagnosis, 208 had an IBD diagnosis, 31 had a colorectal cancer diagnosis, 80 had more than one diagnosis and 3754 had no subsequent diagnosis. Sensitivity, specificity, and positive and negative predictive values were 92.9% (88.6% to 95.6%), 61.5% (60.2% to 62.7%), 8.1% (7.1% to 9.2%) and 99.6% (99.3% to 99.7%), respectively, at the threshold of 50 µg/g. Raising the threshold to 100 µg/g missed less than 7% additional IBD cases. Longer follow-up had no effect on test accuracy. Overall, uncertainty was greater for specificity than sensitivity. General practitioners’ (GPs’) referral decisions did not follow the anticipated clinical pathways in national guidance.Conclusions GPs can be confident in excluding IBD on the basis of a negative FC test in a population with low pretest risk but should interpret a positive test with caution. The applicability of national guidance to general practice needs to be improved.
format	article
author	Ronan Ryan Karoline Freeman Brian H Willis Aileen Clarke
author_facet	Ronan Ryan Karoline Freeman Brian H Willis Aileen Clarke
author_sort	Ronan Ryan
title	Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data
title_short	Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data
title_full	Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data
title_fullStr	Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data
title_full_unstemmed	Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data
title_sort	test accuracy of faecal calprotectin for inflammatory bowel disease in uk primary care: a retrospective cohort study of the thin data
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/f8bee55622b14072b6fe4e8f6c32081c
work_keys_str_mv	AT ronanryan testaccuracyoffaecalcalprotectinforinflammatoryboweldiseaseinukprimarycarearetrospectivecohortstudyofthethindata AT karolinefreeman testaccuracyoffaecalcalprotectinforinflammatoryboweldiseaseinukprimarycarearetrospectivecohortstudyofthethindata AT brianhwillis testaccuracyoffaecalcalprotectinforinflammatoryboweldiseaseinukprimarycarearetrospectivecohortstudyofthethindata AT aileenclarke testaccuracyoffaecalcalprotectinforinflammatoryboweldiseaseinukprimarycarearetrospectivecohortstudyofthethindata
_version_	1718439739561869312

Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

Ejemplares similares