PREDICTING ENDOSCOPIC DIAGNOSIS IN THE DYSPEPTIC PATIENT - THE VALUE OF PREDICTIVE SCORE MODELS

Background: Score models to predict endoscopic diagnosis in dyspepsia may compensate for the unreliable clinical diagnosis. This study aimed to construct and test score models designed to predict diagnosis in d yspepstic patients managed in primary care. Methods: Three models to p redict organic dyspepsia, major dyspepsia or peptic ulcer were constru cted by regression analysis of clinical data from 1026 consecutive dys peptic patients referred for endoscopy. The models were tested in 207 patients in primary care, who were potential candidates for endoscopy. Validation experiments were analysed using receiver operating charact eristic (ROC) curves. Results: Significant losses of predictive power were found for all models when applied to primary care patients, and n o model could be used as a reliable decision support instrument in pri mary care. Conclusions: Predictive score models developed in patients referred for endoscopy are not reliable when applied to patients in pr imary care who are potential candidates for endoscopy. Future models s hould be constructed and validated in unselected primary care populati ons.