Dataset Information

A case-control study of presentations in general practice before diagnosis of coeliac disease.

ABSTRACT:

Background

Delay in the diagnosis of coeliac disease prolongs morbidity and may increase mortality. Little is known about presentations in general practice that may predict a subsequent diagnosis of coeliac disease.

Aim

To examine presentations in general practice during the 5 years prior to diagnosis of coeliac disease.

Design of study

A case-control study with each biopsy-proven coeliac disease case matched by age, sex, and general practice to an average of two controls.

Setting

Thirty-seven general practices in south-east Wales.

Method

Cases were identified via a secondary care clinic and controls recruited from the general practices of cases. General practice clinical records of both cases and controls were analysed to determine frequency of consultations, presenting symptoms, diagnoses, referrals, and investigations during the 5 years prior to diagnosis.

Results

Cases (n = 68) had an increased number of consultations compared with controls (n = 160) during the 5 years prior to diagnosis (mean difference five consultations, P = 0.001). Three clinical features were independently associated with subsequent diagnosis of coeliac disease: depression and/or anxiety (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.1 to 5.7, P = 0.031); diarrhoea (OR = 4.5, 95% CI = 2.0 to 10.0, P <0.001); and anaemia (OR = 26.3, 95% CI = 5.7 to 120.6, P <0.001). Both diarrhoea and anaemia remained associated even when data for the year prior to diagnosis was excluded from the analysis.

Conclusion

[corrected] GPs should consider testing for coeliac disease when patients present often, especially with diarrhoea and/or who are discovered to be anaemic. Further research is required to clarify the role of depression and/or anxiety in the diagnosis of coeliac disease.

SUBMITTER: Cannings-John R

PROVIDER: S-EPMC2099669 | biostudies-literature | 2007 Aug

REPOSITORIES: biostudies-literature

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Publications

A case-control study of presentations in general practice before diagnosis of coeliac disease.

Cannings-John Rebecca R Butler Christopher C CC Prout Hayley H Owen Diane D Williams Della D Hood Kerenza K Crimmins Rosemary R Swift Gillian G

The British journal of general practice : the journal of the Royal College of General Practitioners 20070801 541

<h4>Background</h4>Delay in the diagnosis of coeliac disease prolongs morbidity and may increase mortality. Little is known about presentations in general practice that may predict a subsequent diagnosis of coeliac disease.<h4>Aim</h4>To examine presentations in general practice during the 5 years prior to diagnosis of coeliac disease.<h4>Design of study</h4>A case-control study with each biopsy-proven coeliac disease case matched by age, sex, and general practice to an average of two controls.< ...[more]

PMID: 17688758

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Project description:ObjectivesHeart failure (HF) is a commonly occurring health problem with high mortality and morbidity. If potential cases could be detected earlier, it may be possible to intervene earlier, which may slow progression in some patients. Preferably, it is desired to reuse already measured data for screening of all persons in an age group, such as general practitioner (GP) data. Furthermore, it is essential to evaluate the number of people needed to screen to find one patient using true incidence rates, as this indicates the generalisability in the true population. Therefore, we aim to create a machine learning model for the prediction of HF using GP data and evaluate the number needed to screen with true incidence rates.Design, settings and participantsGP data from 8543 patients (-2 to -1 year before diagnosis) and controls aged 70+ years were obtained retrospectively from 01 January 2012 to 31 December 2019 from the Nivel Primary Care Database. Codes about chronic illness, complaints, diagnostics and medication were obtained. Data were split in a train/test set. Datasets describing demographics, the presence of codes (non-sequential) and upon each other following codes (sequential) were created. Logistic regression, random forest and XGBoost models were trained. Predicted outcome was the presence of HF after 1 year. The ratio case:control in the test set matched true incidence rates (1:45).ResultsSole demographics performed average (area under the curve (AUC) 0.692, CI 0.677 to 0.706). Adding non-sequential information combined with a logistic regression model performed best and significantly improved performance (AUC 0.772, CI 0.759 to 0.785, p<0.001). Further adding sequential information did not alter performance significantly (AUC 0.767, CI 0.754 to 0.780, p=0.07). The number needed to screen dropped from 14.11 to 5.99 false positives per true positive.ConclusionThis study created a model able to identify patients with pending HF a year before diagnosis.

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Dataset Information

A case-control study of presentations in general practice before diagnosis of coeliac disease.

Background

Aim

Design of study

Setting

Method

Results

Conclusion

Publications

A case-control study of presentations in general practice before diagnosis of coeliac disease.

Similar Datasets

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