Watjer Roeland M, Bonten Tobias N, Arkesteijn Maikel Ahm, Quint Koen D, van der Beek Martha T, van der Raaij-Helmer Liesbeth Mh, Numans Mattijs E, Eekhof Just Ah
Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
BJGP Open. 2023 Sep 19;7(3). doi: 10.3399/BJGPO.2022.0186. Print 2023 Sep.
Onychomycosis, the most common cause of nail dystrophy, is generally diagnosed by clinical examination. Current guidelines for Dutch general practice advise confirmatory testing only in cases of doubt or insufficient response to treatment. However, making a correct diagnosis can be challenging given the wide variety of clinical features and differential diagnosis.
To establish accuracy of clinical diagnosis of onychomycosis by GPs.
DESIGN & SETTING: A diagnostic accuracy study based on GPs' clinical diagnosis of primary care patients suspected of onychomycosis.
Using 137 complete datasets from the Onycho Trial, diagnostic accuracy of clinical diagnosis as the index test was compared with confirmatory testing as the reference test. A sensitivity analysis was performed to determine diagnostic values for different combinations of index and reference test. Logistical regression was used to assess which clinical characteristics were associated with the positive predictive value (PPV) of the index test.
Clinical accuracy, that is the PPV of the index test, was 74.5%. Sensitivity analysis showed no significant difference in diagnostic values. Male sex and a history of any previous treatment significantly increased clinical accuracy with an odds ratio (OR) of 3.873 (95% confidence interval [CI] = 1.230 to 12.195, = 0.021) and OR 4.022 (95% CI = 1.075 to 15.040, = 0.039), respectively.
The study demonstrated that the GPs' clinical diagnosis of onychomycosis was insufficiently accurate to initiate treatment without confirmatory testing. Further research is needed to investigate how to increase clinical accuracy and reduce potentially unnecessary exposure to treatment.
甲癣是指甲营养不良最常见的病因，通常通过临床检查进行诊断。荷兰全科医疗的现行指南建议仅在存在疑问或治疗反应不足的情况下进行确诊检测。然而，鉴于临床特征和鉴别诊断的多样性，做出正确诊断可能具有挑战性。
确定全科医生对甲癣临床诊断的准确性。
一项基于全科医生对疑似甲癣初级保健患者临床诊断的诊断准确性研究。
使用来自甲癣试验的137个完整数据集，将作为指标测试的临床诊断的诊断准确性与作为参考测试的确诊检测进行比较。进行敏感性分析以确定指标测试和参考测试不同组合的诊断价值。使用逻辑回归评估哪些临床特征与指标测试的阳性预测值（PPV）相关。
临床准确性，即指标测试的PPV，为74.5%。敏感性分析显示诊断价值无显著差异。男性和既往任何治疗史分别使临床准确性显著提高，优势比（OR）为3.873（95%置信区间[CI]=1.230至12.195，P=0.021）和OR 4.022（95%CI=1.075至15.040，P=0.039）。
该研究表明，全科医生对甲癣的临床诊断准确性不足，在没有确诊检测的情况下不足以开始治疗。需要进一步研究以探讨如何提高临床准确性并减少潜在的不必要治疗暴露。
