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The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study

BACKGROUND: 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 chall...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646193/
https://www.ncbi.nlm.nih.gov/pubmed/37185166
http://dx.doi.org/10.3399/BJGPO.2022.0186
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author 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
author_facet 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
author_sort Watjer, Roeland M
collection PubMed
description BACKGROUND: 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. AIM: 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. METHOD: 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. RESULTS: 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, P = 0.021) and OR 4.022 (95% CI = 1.075 to 15.040, P = 0.039), respectively. CONCLUSION: 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.
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spelling pubmed-106461932023-06-28 The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study 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 BJGP Open Research BACKGROUND: 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. AIM: 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. METHOD: 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. RESULTS: 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, P = 0.021) and OR 4.022 (95% CI = 1.075 to 15.040, P = 0.039), respectively. CONCLUSION: 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. Royal College of General Practitioners 2023-06-28 /pmc/articles/PMC10646193/ /pubmed/37185166 http://dx.doi.org/10.3399/BJGPO.2022.0186 Text en Copyright © 2023, The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Research
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
The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study
title The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study
title_full The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study
title_fullStr The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study
title_full_unstemmed The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study
title_short The accuracy of clinical diagnosis of onychomycosis in Dutch general practice: a diagnostic accuracy study
title_sort accuracy of clinical diagnosis of onychomycosis in dutch general practice: a diagnostic accuracy study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10646193/
https://www.ncbi.nlm.nih.gov/pubmed/37185166
http://dx.doi.org/10.3399/BJGPO.2022.0186
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