The Diagnostic Value of Scoring Models for Organic and Non-organic Gastrointestinal Disease, Including the Irritable-bowel Syndrome

Abstract

Scoring models based on history and physical examination have been developed to discriminate patients with non-organic gastrointestinal disease from those who have organic disease. The application of these models may lead to more efficient diagnosis and prevent somatization. Although the models have high diagnostic accuracy in the population in which they have been developed, their value in other populations has not been established. In this study previously developed models were tested in validation populations defined by the original selection criteria from the studies in which the models were developed and in unselected general practice and outpatient populations. The diagnostic performance of the models are expressed in terms of odds ratio and sensitivity and specificity for the classification of patients as having organic and non-organic disease. The diagnostic performance of all the models were rather low in the validation populations. Relatively few elements of the models had independent diagnostic value. In addition, the correlation between the scoring models, expressed in Cohen's kappa, was extremely low. The diagnostic values of the scoring models were not reproduced in comparable and unselected populations. Therefore, it is concluded that the diagnostic value of such a model has little external validity.

The diagnosis of IBS in primary care: consensus development using nominal group technique

“…4 These are derived from the characteristics of patients in secondary care and they are little used in primary care. 5 Though useful for the definition of research populations, they have been challenged as both lacking external validity for the primary care population 6 and being unnecessarily restrictive for clinical practice. 7 In some studies of primary care patients diagnosed with IBS, only a minority fulfilled the Rome II criteria.…”

Knowledge about Colorectal Cancer in Northern Iran: a Population-Based Telephone Survey

“…In contrast, only 63.3% of participants in our study recognized bowel bleeding as a symptom of CRC and 55.8% associated change of bowel habit with CRC. Although there is evidence that bleeding may be the better predictor of bowel cancer, the findings suggest that more education regarding changes in bowel habits as an early symptom may be needed (Starmans et al, 1994;Muris et al, 1995).…”

Effect modification by setting: how usual is usual care?

“…Effect modification by disease spectrum and clinical setting has theoretically and empirically been recognized for quite some time [1,2], and has also been addressed previously in this journal [3,4]. However, this key insight is still not fully integrated in clinical research and clinical guidelines.…”