The Resource Diagnosis of gout, investigators, Sydne J. Newberry, John FitzGerald, Margaret A. Maglione, Claire E. O'Hanlon, Dan Han, Marika Booth, Aneesa Motala, Abdul Tariq, Whitney Dudley, Roberta Shanman, Paul G. Shekelle

Diagnosis of gout, investigators, Sydne J. Newberry, John FitzGerald, Margaret A. Maglione, Claire E. O'Hanlon, Dan Han, Marika Booth, Aneesa Motala, Abdul Tariq, Whitney Dudley, Roberta Shanman, Paul G. Shekelle

Label
Diagnosis of gout
Title
Diagnosis of gout
Statement of responsibility
investigators, Sydne J. Newberry, John FitzGerald, Margaret A. Maglione, Claire E. O'Hanlon, Dan Han, Marika Booth, Aneesa Motala, Abdul Tariq, Whitney Dudley, Roberta Shanman, Paul G. Shekelle
Title variation
Effective Health Care Program
Creator
Contributor
Author
Researcher
Sponsoring body
Subject
Genre
Language
eng
Summary
OBJECTIVES: The aim of this review is to assess the evidence for the accuracy and safety of tests to diagnose gout in patients with no prior diagnosis of gout. The review also assesses factors that affect accuracy of diagnostic tests. Tests include algorithms that combine clinical signs and symptoms, dual-energy computed tomography (DECT), ultrasound, and plain x ray, with particular emphasis on tests that can be conducted in primary and acute (urgent and emergent) care settings. DATA SOURCES: We searched Medline(r) (from 1946), Embase(r) (from 1972), the Cochrane Library (from 1945), and the Web of Science" (from 1980) to November 7, 2014, for published studies. We also searched ClinicalTrials.gov and the Web of Science and contacted manufacturers of imaging equipment and test kits for unpublished data on gout diagnosis. REVIEW METHODS: We reviewed published and unpublished prospective cohort, cross-sectional, and case-control studies, as well as prior systematic reviews on the accuracy (sensitivity and specificity) of diagnostic tests for gout compared with a validated reference standard in patients without a prior gout diagnosis. We also reviewed studies and prior reviews of factors affecting the accuracy of monosodium urate crystal assessment in synovial fluid. We reviewed prospective cohort, cross-sectional, and case-control studies; case reports of any size; and systematic reviews that reported adverse events associated with diagnostic tests for gout and outcomes of gout misdiagnosis. A standardized protocol with predefined criteria was used to extract details on study design, interventions, outcomes, and study quality, and to assess the strength of evidence for each conclusion. RESULTS: Six clinical algorithms comprising clinical signs and symptoms have been tested for diagnostic accuracy against the presence of monosodium urate crystals in synovial fluid aspirated from affected joints. Most studies were conducted with small groups of patients in academic rheumatology departments. Two recently developed clinical algorithms, the Diagnostic Rule, which is the only one developed and validated with primary care physicians and patients, and the Clinical Gout Diagnosis (CGD), demonstrated sensitivities of 88 percent and 97 percent, respectively, and specificities of 75 percent and 96 percent, respectively, in patients with shorter (2 years or less) and longer durations of symptoms, and they are simple to administer. However, the strength of evidence supporting their use is low, as validation of these tools remains limited. Three studies of DECT that enrolled patients without a previous gout diagnosis revealed sensitivities ranging from 85 percent to 100 percent and specificities ranging from 83 percent to 92 percent in diagnosing gout; the strength of evidence regarding the use of DECT for gout diagnosis is low. Four studies of ultrasound that enrolled patients without a previous diagnosis showed sensitivities ranging from 37 percent to 100 percent and specificities ranging from 68 percent to 97 percent, depending on the ultrasound signs assessed; the strength of evidence is low for the utility of ultrasound in diagnosing gout. A small number of studies examined factors that affected the accuracy of tests for the diagnosis of gout. The accuracy of monosodium urate analysis in synovial fluid varies widely among practitioners, but evidence on the effects of skill and experience is insufficient. No studies examined differences among practitioners in the rate of successful joint aspiration. No studies reported adverse events directly associated with techniques used to diagnose gout. However in one small study, missed gout diagnosis resulted in unnecessary surgery, longer hospital stays, and delay in appropriate treatment. CONCLUSIONS: Promising diagnostic clinical algorithms such as the Diagnostic Rule and CGD need to be validated more broadly in primary and urgent care settings. A clinical algorithm with high diagnostic accuracy ideally can form part of a diagnostic decision tree, with referral of more clinically challenging cases to rheumatologists for more invasive tests or imaging. Research is needed to assess the incremental value of synovial fluid monosodium urate crystal analysis and imaging over that of a diagnostic clinical algorithm
Member of
Cataloging source
NLM
http://bibfra.me/vocab/relation/commissioningbody
SGEpYsXqBGk
http://library.link/vocab/creatorName
Newberry, Sydne J
Funding information
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services 5600 Fishers Lane, Rockville, MD 20857; www.ahrq.gov. Contract No. 290-2012-00006-I. Prepared by: Southern California Evidence-based Practice Center, Santa Monica, CA
Government publication
federal national government publication
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • surveys of literature
NLM call number
WE 350
http://library.link/vocab/relatedWorkOrContributorName
  • United States
  • Southern California Evidence-Based Practice Center/RAND
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • number 158
  • No. 15(16)-EHC026-EF
http://library.link/vocab/subjectName
  • Gout
  • Comparative Effectiveness Research
  • Randomized Controlled Trials as Topic
  • Sensitivity and Specificity
Label
Diagnosis of gout, investigators, Sydne J. Newberry, John FitzGerald, Margaret A. Maglione, Claire E. O'Hanlon, Dan Han, Marika Booth, Aneesa Motala, Abdul Tariq, Whitney Dudley, Roberta Shanman, Paul G. Shekelle
Instantiates
Publication
Note
"February 2016."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
952657033
Extent
1 online resource :
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Specific material designation
remote
System control number
(OCoLC)952657033
Label
Diagnosis of gout, investigators, Sydne J. Newberry, John FitzGerald, Margaret A. Maglione, Claire E. O'Hanlon, Dan Han, Marika Booth, Aneesa Motala, Abdul Tariq, Whitney Dudley, Roberta Shanman, Paul G. Shekelle
Publication
Note
"February 2016."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier
Content category
  • text
  • still image
Content type code
  • txt
  • sti
Content type MARC source
  • rdacontent
  • rdacontent
Control code
952657033
Extent
1 online resource :
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
c
Specific material designation
remote
System control number
(OCoLC)952657033

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