NONACUTE ABDOMINAL COMPLAINTS IN GENERAL-PRACTICE - DIAGNOSTIC-VALUE OF SIGNS AND SYMPTOMS

Background. Although many patients are evaluated initially by their ge neral practitioner, clinicians' accuracy at diagnosing organic gastroi ntestinal disease has not been studied in a primary care setting. Diff erent spectra of severity of diseases in general practice and hospital populations may lead to different values for diagnostic tests in thes e two populations. Aim. This study set out to determine the diagnostic value of history and physical and laboratory items for organic and ne oplastic disease in general practice patients with nonacute abdominal complaints. Method. The one-year prospective, observational study was carried out in 1989 in 80 general practices in Limburg, the Netherland s. The study subjects were 933 patients (aged 18-75 years) presenting to their general practitioner with new non-acute abdominal complaints of minimum duration two weeks, and with whom the doctor had a diagnost ic problem. Patients were physically examined by their general practit ioner and asked to complete pre-structured questionnaires. Basic labor atory tests were carried out. Patients were followed up for at least o ne year by researchers and then a diagnosis was determined by an indep endent panel of three general practitioners using patient records, bli nded for the results of the questionnaires. Sensitivity, specificity a nd odds ratios were calculated for clinical items. Stepwise forward lo gistic regression analysis was undertaken to identify independent pred ictors of organic gastrointestinal disease. Results. Of the 933 patien ts 14% had organic gastrointestinal disease. No clinical item had both high sensitivity and specificity. Logistic regression analysis showed only eight independent predictors of organic disease: male sex, great er age, epigastric pain, no specific character to pain, pain affecting sleep, history of blood in stool, no pain relief after defecation and abnormal white blood cell count. When the model was programmed to pre dict neoplasms five items were found: male sex, greater age, no specif ic character to pain, weight loss and erythrocyte sedimentation rate g reater than 20 mm hour(-1). Conclusion. In a general practice populati on with non-acute abdominal complaints some clinical findings can be u sed as predictors for organic and neoplastic gastrointestinal disease.