Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

Freeman, Karoline; Taylor‐Phillips, Sian; Willis, Brian H; Ryan, Ronan; Clarke, Aileen

doi:10.1136/bmjopen-2020-044177

Cited by 12 publications

(15 citation statements)

References 30 publications

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“…FC testing has a high negative predictive value of 99.6% (95% CI = 99.3% to 99.7%) at this threshold (and a positive predictive value of 8.1%, 95% CI = 7.1% to 9.2%). 26 Nevertheless, the present study showed that nearly 50% of patients with an FC level <50 µg/g were referred into secondary care services. This is in agreement with reported estimates from several primary care studies.…”

Section: Discussioncontrasting

confidence: 55%

Faecal calprotectin testing in UK general practice: a retrospective cohort study using The Health Improvement Network database

et al. 2021

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BackgroundFaecal calprotectin (FC) testing to detect inflammatory bowel disease (IBD) was recommended for use in UK general practice in 2013. The actual use of FC testing following the national recommendations is unknown.AimTo characterise the use of FC testing for IBD in UK general practice.Design and settingA retrospective cohort study of routine electronic patient records from The Health Improvement Network database from UK general practice.MethodThe study included 6 965 853 adult patients (aged ≥18 years), between 2006 and 2016. FC test uptake, the patients tested, and patient management following testing were characterised.ResultsA total of 17 027 patients had 19 840 FC tests recorded. The mean age of tested patients was 44.2 years. The first FC tests were documented in 2009. FC test use was still increasing in 2016. By 2016, 66.8% (n = 493/738) of practices had started FC testing. About one-fifth (20.7%, n = 1253/6051) of tests were carried out in patients aged ≥60 years. Only 7.8% (n = 473/6051) of the FC test records were preceded by symptoms eligible for FC testing. Only 3.1% (n = 1720/55 477) of patients with eligible symptoms have received FC testing since the national recommendations were published. There was only a small number of patients with symptoms, FC test, and a IBD diagnosis. In total, 71.3% (n = 1416/1987) of patients with a positive and 47.7% (n = 1337/2805) with a negative FC test were referred or further investigated.ConclusionUptake of FC testing in clinical practice has been slow and inconsistent. The indication of non-compliance with national recommendations may suggest that these recommendations lack applicability to the general practice context.

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Section: Discussioncontrasting

confidence: 55%

Faecal calprotectin testing in UK general practice: a retrospective cohort study using The Health Improvement Network database

et al. 2021

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“… 26 Routinely collected data have also been used to evaluate the test accuracy of faecal calprotectin at different thresholds in the diagnosis of inflammatory bowel disease. 27 …”

Section: Discussionmentioning

confidence: 99%

Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study

et al. 2022

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Background: Natriuretic peptide (NP) testing is recommended for patients presenting to primary care with symptoms of chronic heart failure (HF) to prioritise referral for diagnosis. Aim: To report NP test performance at European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guideline referral thresholds. Design and Setting: Diagnostic accuracy study using linked primary and secondary care data (2004-2018). Methods: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of NP test for HF diagnosis. Results: 229,580 patients had a NP test and 21,102 (9.2%) were diagnosed with HF within six months. The ESC NT-proBNP threshold ≥125pg/ml had a sensitivity of 94.6% (95% confidence interval 94.2 to 95.0), and specificity 50.0% (49.7 to 50.3) compared to sensitivity of 81.7% (81.0 to 82.3) and specificity of 80.3% (80.0 to 80.5) for the NICE NT-proBNP ≥400pg/ml threshold. PPVs for a NT-proBNP test were 16.4% (16.1 to 16.6) and 30.0% (29.6 to 30.5) for ESC and NICE thresholds, respectively. For both guidelines, nearly all patients with a NT-proBNP level below the threshold did not have HF (NPV: ESC 98.9% (98.8 to 99.0) and NICE 97.7% (97.6 to 97.8). Conclusions: At the higher NICE chronic HF guideline NP thresholds, one in five cases are initially missed in primary care but the lower ESC thresholds require more diagnostic assessments. NP is a reliable ‘rule-out’ test at both cut-points. The optimal NP threshold will depend on the priorities and capacity of the healthcare system.

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“…In this comparison, the tailored results were compared to the ‘true’ estimates for primary care from an independent study of routine primary care data [ 8 ]. That study may or may not be biased.…”

Section: Discussionmentioning

confidence: 99%

“…That study may or may not be biased. However, considering all strengths and limitations discussed previously [ 8 ], it probably represents the best estimate we are likely to achieve on the test performance of faecal calprotectin as it is used in UK primary care without conducting a de novo cross sectional study under tightly controlled study conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Estimates of sensitivity and specificity from the meta-analysis were compared to estimates from an independent primary care test accuracy study using the same primary care THIN dataset. Details of the study are published elsewhere [ 8 ]. In brief, in our analysis we considered 5970 patients with at least 6 months of follow-up data (for an analysis where an IBD diagnosis was considered when it was recorded within 6 months of the FC test) of the 7084 patients we identified who had had an FC test and no prior IBD diagnosis since registration with the general practice.…”

Section: Methodsmentioning

confidence: 99%

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Comparing outcomes from tailored meta-analysis with outcomes from a setting specific test accuracy study using routine data of faecal calprotectin testing for inflammatory bowel disease

Freeman

Willis

Ryan

et al. 2022

BMC Med Res Methodol

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Background Meta-analyses of test accuracy studies may provide estimates that are highly improbable in clinical practice. Tailored meta-analysis produces plausible estimates for the accuracy of a test within a specific setting by tailoring the selection of included studies compatible with a specific setting using information from the target setting. The aim of this study was to validate the tailored meta-analysis approach by comparing outcomes from tailored meta-analysis with outcomes from a setting specific test accuracy study. Methods A retrospective cohort study of primary care electronic health records provided setting-specific data on the test positive rate and disease prevalence. This was used to tailor the study selection from a review of faecal calprotectin testing for inflammatory bowel disease for meta-analysis using the binomial method and the Mahalanobis distance method. Tailored estimates were compared to estimates from a study of test accuracy in primary care using the same routine dataset. Results Tailoring resulted in the inclusion of 3/14 (binomial method) and 9/14 (Mahalanobis distance method) studies in meta-analysis. Sensitivity and specificity from tailored meta-analysis using the binomial method were 0.87 (95% CI 0.77 to 0.94) and 0.65 (95% CI 0.60 to 0.69) and 0.98 (95% CI 0.83 to 0.999) and 0.68 (95% CI 0.65 to 0.71), respectively using the Mahalanobis distance method. The corresponding estimates for the conventional meta-analysis were 0.94 (95% CI 0.90 to 0.97) and 0.67 (95% CI 0.57 to 0.76) and for the FC test accuracy study of primary care data 0.93 (95%CI 0.89 to 0.96) and 0.61 (95% CI 0.6 to 0.63) to detect IBD at a threshold of 50 μg/g. Although the binomial method produced a plausible estimate, the tailored estimates of sensitivity and specificity were not closer to the primary study estimates than the estimates from conventional meta-analysis including all 14 studies. Conclusions Tailored meta-analysis does not always produce estimates of sensitivity and specificity that lie closer to the estimates derived from a primary study in the setting in question. Potentially, tailored meta-analysis may be improved using a constrained model approach and this requires further investigation.

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Test accuracy of faecal calprotectin for inflammatory bowel disease in UK primary care: a retrospective cohort study of the THIN data

Cited by 12 publications

References 30 publications

Faecal calprotectin testing in UK general practice: a retrospective cohort study using The Health Improvement Network database

Faecal calprotectin testing in UK general practice: a retrospective cohort study using The Health Improvement Network database

Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study

Comparing outcomes from tailored meta-analysis with outcomes from a setting specific test accuracy study using routine data of faecal calprotectin testing for inflammatory bowel disease

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