Diagnostic accuracy and trajectories of referrals for gout to rheumatology
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
• Non-rheumatologists, especially those in acute care specialties, are accurate in diagnosing gout, suggesting care gaps stem from suboptimal treatment, rather than inaccurate diagnosis • Gout mimickers include conditions with mono/oligoarticular involvement and/or intermittent periods of disease flares • Male sex, serum urate ≥500 µmol/L, lower extremity monoarthritis and symptom duration ≤2 weeks may be useful at point of referral triage to ascertain a final gout diagnosis Objectives: To evaluate diagnostic accuracy and trajectories of gout referrals to rheumatology including factors associated with an accurate diagnosis. Methods: We performed a retrospective cohort study of referrals at 4 rheumatology clinics in Brampton, Canada from December 2019 to January 2023. We assessed gout diagnostic accuracy referenced to the rheumatologist’s “gold standard” diagnosis, describing alternative final diagnoses. Using multivariable logistic regression, we identified factors associated with an accurate gout diagnosis. Results: Among 4,315 patients, 216 were diagnosed with gout. Of 191 gout referrals (mean (SD) age 58.4 (15.4) years; 77.0% male), the diagnosis was unchanged in 159 (83.2%) patients with alternative diagnoses comprising osteoarthritis, autoimmune inflammatory arthritis and calcium pyrophosphate deposition disease. Referring physicians had moderate-to-high sensitivity (73.6%, 95% CI: 67.2–79.4), specificity (99.2%, 95% CI: 98.9–99.5), positive predictive value (83.2%, 95% CI: 77.2–88.2), negative predictive value (98.6%, 95% CI: 98.2–99.0) and inter-rater reliability (Cohen’s kappa: 0.77, 95% CI: 0.72–0.82). Accuracy was highest amongst internists and emergency room physicians. Male sex (OR 14.32, 95% CI: 4.44–46.17), serum urate ≥500 µmol/L (OR 9.10, 95% CI: 2.19–7.78), lower extremity monoarthritis (OR 5.08, 95% CI: 1.59–16.27) and symptom duration ≤2 weeks (OR 3.87, 95% CI 1.23–12.21) were predictive of a final gout diagnosis. Conclusions: Referring providers had reasonably high accuracy in diagnosing gout. Traditional risk factors were associated with concordance with the consultant rheumatologist. Suboptimal gout care likely does not stem at point-of-diagnosis and quality improvement efforts should be focused on mitigating treatment-associated care gaps.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it