Validez de las pruebas utilizadas en el diagnóstico inicial y su concordancia con el diagnóstico final en pacientes con sospecha de hiperplasia benigna de próstata
Validity Of Tests For Initial Diagnosis And Its Concordance With Final Diagnosis In Patients With Suspected Benign Prostatic Hyperplasia
J. Carballido Rodríguez*, X. Badia Llach**,1
, A. Gimeno Collado***, L. Regadera Sejas****, R. Dal-Ré Saavedra****, M. Guilera Sardá**
Autor para correspondencia
mxbadia@hor-europe.co
Dr. X. Badia Health Outcomes Research Europe Avda. Diagonal 618, 1 C-D Barcelona 08021
Dr. X. Badia Health Outcomes Research Europe Avda. Diagonal 618, 1 C-D Barcelona 08021
* Servicio Urología. Hospital Universitario Clínica Puerta de Hierro. Madrid
** Health Outcomes Research Europe. Barcelona. Hospital Universitario Clínica Puerta de Hierro. Madrid
*** Servicio de Urología. Hospital General de la Mancha. Ciudad Real. Hospital Universitario Clínica Puerta de Hierro. Madrid
**** Departamento Médico. GlaxoSmithKline. S.A. Hospital Universitario Clínica Puerta de Hierro. Madrid
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"apellidos" => "Carballido Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "X." "apellidos" => "Badia Llach" "email" => array:1 [ 0 => "mxbadia@hor-europe.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Gimeno Collado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">***</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Regadera Sejas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">****</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "R." 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Madrid" "etiqueta" => "<span class="elsevierStyleSup">***</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento Médico. GlaxoSmithKline. S.A. Hospital Universitario Clínica Puerta de Hierro. Madrid" "etiqueta" => "****" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Dr. X. Badia Health Outcomes Research Europe Avda. Diagonal 618, 1 C-D Barcelona 08021" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Validity Of Tests For Initial Diagnosis And Its Concordance With Final Diagnosis In Patients With Suspected Benign Prostatic Hyperplasia" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-04-05" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras claves" "identificador" => "xpalclavsec87946" "palabras" => array:3 [ 0 => "Hiperplasia benigna de próstata" 1 => "Diagnóstico" 2 => "Atención primaria" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec87945" "palabras" => array:3 [ 0 => "Benign prostatic hyperplasia" 1 => "Diagnosis" 2 => "Primary health care" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la validez de los métodos diagnósticos al alcance del primer escalón del nivel asistencial [historia clínica (HC), cuestionario I-PSS, tacto rectal (TR) y determinación del antígeno prostático específico (PSA)], para el diagnóstico de la hiperplasia benigna de próstata (HBP)</p> <span class="elsevierStyleSectionTitle">Población y Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Participaron 363 pacientes atendidos en consultas externas de urología por sospecha de HBP. El diagnóstico inicial de HBP se fue realizando tras la aplicación secuencial de cada una de las siguientes pruebas: 1) HC 2) I-PSS 3) TR y 4) PSA. El diagnóstico emitido tras cada uno de los 4 pasos, se contrastó con el diagnóstico final (gold standard) tras la evaluación de sedimento urinario, volumen miccional residual y tamaño prostático por ecografía y flujometría urinaria. Se realizó un análisis descriptivo y se calculó la validez y concordancia entre cada paso diagnóstico y el gold standard</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del diagnóstico basado en HC+IPSS+ TR+PSA con respecto al diagnóstico final fueron 91%, 65%, 95% y 50% respectivamente. El porcentaje de acuerdo y el índice kappa entre ambos diagnósticos fueron 87,9% y 0,5, respectivamente</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La concordancia entre el diagnóstico inicial basada en la historia clínica, cuestionario I-PSS, TR y PSA, y el diagnóstico final de HBP es alta, lo que permite recomendar el uso del conjunto de estas pruebas accesibles en el primero de los escalones asistenciales no sólo como primer paso diagnóstico en los pacientes con sospecha de HBP, sino también como estrategia válida para evitar retrasos innecesarios en su manejo inicial y facilitar la adecuada derivación entre los niveles de atención primaria y especializada</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the validity of diagnostic tools available at the primary care setting [medical history (MH), I-PSS questionnaire, digital rectal examination (DRE) and prostate specific antigen (PSA) evaluation] for the diagnosis of benign prostatic hyperplasia (BPH)</p> <span class="elsevierStyleSectionTitle">Subjects and Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">363 patients with suspected prostatic disease referred to urology outpatient clinics were included. For every subject initial BPH diagnosis was collected at each of the following sequential procedures: 1) MH; 2) I-PSS; 3) DRE; and 4) PSA. Each of these diagnostic decisions were compared to a final diagnosis (gold standard) reached after the addition of urinary sediment analysis, ultrasonographic assessment of residual volume and prostatic volume, and peak urinary flow measurement. A descriptive analysis was undertaken; validity and concordance between each diagnostic step and the gold standard was calculated</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosis based on MH+IPSS+ DRE+PSA with respect to the gold standard were 91%, 65%, 95% and 50%, respectively. The percentage of agreement and kappa index between both diagnostic strategies were 87.9% and 0.5, respectively</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Concordance between BPH initial diagnosis based on MH+I-PSS+DRE+PSA and diagnosis based on a full range of tests was high, thus allowing recommending the use of this group of initial diagnostic procedures, which are available to the primary care physician, not only as a first diagnostic step in patients with suspected BPH, but also as a valid strategy to prevent unnecessary delay in its initial management and to facilitate appropriate referral from primary to specialized care</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 0 | 1 | 1 |
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| 2021 Diciembre | 0 | 7 | 7 |
| 2021 Noviembre | 0 | 3 | 3 |
| 2021 Octubre | 0 | 2 | 2 |
| 2021 Septiembre | 0 | 1 | 1 |
| 2021 Agosto | 0 | 7 | 7 |
| 2021 Julio | 0 | 4 | 4 |
| 2021 Junio | 0 | 3 | 3 |
| 2021 Abril | 0 | 6 | 6 |
| 2021 Febrero | 0 | 4 | 4 |
| 2021 Enero | 0 | 3 | 3 |
| 2020 Noviembre | 0 | 5 | 5 |
| 2020 Agosto | 0 | 9 | 9 |
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| 2020 Mayo | 0 | 8 | 8 |
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| 2020 Febrero | 0 | 7 | 7 |
| 2020 Enero | 0 | 13 | 13 |
| 2019 Diciembre | 0 | 14 | 14 |
| 2019 Noviembre | 0 | 6 | 6 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 8 | 8 |
| 2019 Junio | 0 | 14 | 14 |
| 2019 Mayo | 0 | 50 | 50 |
| 2019 Abril | 0 | 23 | 23 |
| 2019 Marzo | 0 | 2 | 2 |
| 2019 Febrero | 4 | 8 | 12 |
| 2019 Enero | 1 | 2 | 3 |
| 2018 Diciembre | 0 | 3 | 3 |
| 2018 Noviembre | 0 | 3 | 3 |
| 2018 Octubre | 0 | 8 | 8 |
| 2018 Febrero | 0 | 6 | 6 |
| 2018 Enero | 2 | 5 | 7 |
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| 2017 Noviembre | 3 | 5 | 8 |
| 2017 Octubre | 2 | 8 | 10 |
| 2017 Septiembre | 3 | 7 | 10 |
| 2017 Agosto | 3 | 9 | 12 |
| 2017 Julio | 7 | 1 | 8 |
| 2017 Junio | 10 | 12 | 22 |
| 2017 Mayo | 14 | 8 | 22 |
| 2017 Abril | 14 | 1 | 15 |
| 2017 Marzo | 8 | 10 | 18 |
| 2017 Febrero | 5 | 10 | 15 |
| 2017 Enero | 4 | 5 | 9 |
| 2016 Diciembre | 20 | 14 | 34 |
| 2016 Noviembre | 31 | 16 | 47 |
| 2016 Octubre | 20 | 14 | 34 |
| 2016 Septiembre | 16 | 6 | 22 |
| 2016 Agosto | 17 | 7 | 24 |
| 2016 Julio | 6 | 2 | 8 |
| 2016 Junio | 14 | 13 | 27 |
| 2016 Mayo | 14 | 18 | 32 |
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| 2016 Marzo | 7 | 13 | 20 |
| 2016 Febrero | 8 | 14 | 22 |
| 2016 Enero | 16 | 21 | 37 |
| 2015 Diciembre | 14 | 28 | 42 |
| 2015 Noviembre | 8 | 16 | 24 |
| 2015 Octubre | 12 | 12 | 24 |
| 2015 Septiembre | 10 | 13 | 23 |
| 2015 Agosto | 10 | 9 | 19 |
| 2015 Julio | 4 | 9 | 13 |
| 2015 Junio | 2 | 5 | 7 |
| 2015 Mayo | 12 | 11 | 23 |
| 2015 Abril | 8 | 13 | 21 |
| 2015 Marzo | 10 | 10 | 20 |
| 2015 Febrero | 6 | 2 | 8 |
| 2015 Enero | 14 | 6 | 20 |
| 2014 Diciembre | 19 | 7 | 26 |
| 2014 Noviembre | 6 | 2 | 8 |
| 2014 Octubre | 10 | 2 | 12 |
| 2014 Septiembre | 10 | 1 | 11 |
| 2014 Agosto | 6 | 0 | 6 |
| 2014 Julio | 15 | 0 | 15 |
| 2014 Junio | 13 | 1 | 14 |
| 2014 Mayo | 9 | 0 | 9 |
| 2014 Abril | 4 | 1 | 5 |
| 2014 Marzo | 11 | 1 | 12 |
| 2014 Febrero | 6 | 0 | 6 |
| 2014 Enero | 6 | 2 | 8 |
| 2013 Diciembre | 5 | 2 | 7 |
| 2013 Noviembre | 9 | 4 | 13 |
| 2013 Octubre | 5 | 3 | 8 |
| 2013 Septiembre | 8 | 3 | 11 |
| 2013 Agosto | 6 | 4 | 10 |
| 2013 Julio | 1 | 0 | 1 |
| 2006 Junio | 349 | 0 | 349 |
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