Prospective analysis of clinician accuracy in the diagnosis of benign anorectal pathology: the value of clinical information

Abstract

Aim: the prevalence of anorectal disorders in general population is high. The aim of this study was to analyze the influence of clinical symptoms on diagnostic accuracy for benign anorectal pathology among different specialists and evaluate the relation ship between diagnostic accuracy and years of professional expe rience.Methods: seven typical cases were selected. In a first interview, participants were shown images and asked to make a diagnosis. Afterwards, images with additional information (clinical symptoms) were used. Two groups (group 1 = general surgeons and group 2 = medical specialists who attended emergency department) completed both phases of the study to analyze the influence of clinical symptoms on the final diagnosis.Results: forty four specialists were interviewed. The percentage of participants making a correct diagnosis in groups 1 and 2, respectively, was as follows: case 1 (perianal abscess): 100 vs. 80.6%, (p = 0.157); case 2 (fissure): 92.3 vs. 51.6% (p = 0.015); case 3 (thrombosed hemorrhoid): 92.3 vs. 74.2% (p = 0.321); case 4 (anal condyloma): 100 vs. 87.1% (p = 0.302); case 5 (rectal prolapse): 100 vs. 83.9% (p = 0.301); case 6 (prolapsed hemorrhoid): 92.3 vs. 29% (p = 0.001), and case 7 (fistula): 100 vs. 67.7% (p = 0.021). There were significant differences in the number of correctly diagnosed cases between groups (p < 0.001). Information about clinical symptoms significantly increased overall and specific accuracy. There was no correlation between experience and accuracy.Conclusions: clinical symptoms are important for diagnostic accuracy in anorectal pathology. Training in anorectal pathology in medical specialists is warranted.

The epidemiology and treatment of anal fissures in a population-based cohort

“…Other research suggests that the accuracy of AF diagnosis depends greatly on the skills of the examining physician. One study from Spain demonstrated that surgeons can identify AF with very high reliability, but primary care providers were much less likely to correctly identify an AF lesion [27]. …”

The importance of training in anorectal pathology among medical specialities

“…In a recent study performed in Spain, the diagnostic accuracy of general practitioners in patients referred to specialists was assessed. Interestingly, the diagnosis of haemorrhoids was much better than that of anal fistula or fissure, the Kappa index in the latter diagnosis being particularly poor [10], and participants in our recent study also found anal fissure to be especially difficult to recognize [7]. This question is especially relevant when coloproctologists have to distinguish between anal fissure and haemorrhoids.…”

“…In a recent study our group provided evidence that the analysis of symptoms has a greater influence on diagnostic accuracy than years of clinical experience [7]. Indeed, when appropriate questions are asked in a structured format, the physical examination is only a secondary element in making the diagnosis.…”