Diagnostic accuracy and trajectories of referrals for gout to rheumatology
Authors' conclusion
Referring providers had reasonably high accuracy in diagnosing gout. Traditional risk factors were associated with concordance with the consultant rheumatologist.
Study context
- Population
- Referrals at 4 rheumatology clinics in Brampton, Canada, December 2019 to January 2023216 diagnosed with gout
- Participants
- 4,315 participants
- Exposure
- Referring physicians' gout diagnosis vs rheumatologist's "gold standard" diagnosis
- Referring physiciansn = 191
- Outcome
- Gout diagnostic accuracy referenced to the rheumatologist's "gold standard" diagnosis
Methodological detailsdiagnostic accuracy, multicentre (4 rheumatology clinics), multivariable logistic regression
- Diagnostic accuracy
- Multicentre (4 rheumatology clinics)
- Multivariable logistic regression
Main finding
As reported in the abstract
Diagnostic accuracy of referring physicians for gout
| Group | Sensitivity | Specificity | PPV | NPV | Cohen's kappa |
|---|---|---|---|---|---|
| Referring physicians | 73.6% (95% CI: 67.2-79.4) | 99.2% (95% CI: 98.9-99.5) | 83.2% (95% CI: 77.2-88.2) | 98.6% (95% CI: 98.2-99.0) | 0.77 (95% CI: 0.72-0.82) |
Referring physicians
Sensitivity73.6% (95% CI: 67.2-79.4)
Specificity99.2% (95% CI: 98.9-99.5)
PPV83.2% (95% CI: 77.2-88.2)
NPV98.6% (95% CI: 98.2-99.0)
Cohen's kappa0.77 (95% CI: 0.72-0.82)
- Diagnosis unchanged among gout referrals
- 159 (83.2%)
Observational data: associations, not effects.
Further findings
Predictors of a final gout diagnosis (multivariable logistic regression)
- Male sex, OR
- 14.32 (4.44-46.17) (95% CI)
- Serum urate ≥500μmol/L, OR
- 9.10 (2.19-37.78) (95% CI)
- Lower extremity monoarthritis, OR
- 5.08 (1.59-16.27) (95% CI)
- Symptom duration ≤2weeks, OR
- 3.87 (1.23-12.21) (95% CI)
Original publication
Diagnostic accuracy and trajectories of referrals for gout to rheumatology. Joint Bone Spine. Published 3 May 2025. doi:10.
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