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• W3017374741 abstract "Purpose: The purpose of this study was to evaluate the added value of radiographs above clinical findings for diagnosing knee osteoarthritis (OA) by general practitioners (GP) and secondary care physicians (SP). Methods: Standardized clinical and radiographic data of 761 individuals with 1185 symptomatic knees from the CHECK cohort (a longitudinal cohort study of patients with early knee complains in primary care, followed for 10 years) were evaluated by clinical experts for the presence of clinically relevant OA. In total, 36 experts were recruited and divided into 18 pairs; 17 pairs were formed by one GP and one SP and 1 pair consisted of two SPs. The paired experts reviewed the same subset of patients, independently. Experts needed to assess whether clinically relevant OA developed during follow-up and to provide certainty scores (ranging from 1 to 100, where 1 was ‘certainly non OA’ and 100 was ‘certainly OA’). Diagnoses and certainty scores were obtained both before and after viewing radiographic data. Clinical ‘uncertain’ cases were defined as the knees which were diagnosed with certainty scores between 30 and 70. Next, each pair held a consensus meeting to obtain a consensus based final diagnosis for those cases the experts disagreed on, except those labelled ‘uncertain’ (expert disagreed, but both scored certainty between 30 and 70). Results: The clinical diagnosis of GP and SP were both partly amended after evaluating radiographic data (P<0.001, kappa=0.72 and 0.63); in the GP group, 69 (6%) OA knees were amended into non-OA after evaluating radiographic data while 81 (7%) non-OA knees were amended into OA; in the SP group this was done for 60 (5%) OA knees and 175 (14%) non-OA knees, respectively. Table 1 shows that diagnostic indicators were improved similarly for GP and SP after viewing the radiographic data, when compared to the final consensus based diagnosis. For both GP and SP the diagnostic indicators for clinical ‘uncertain’ case were improved much more after viewing the radiographic data than for clinical ‘certain’ cases (Table2). Radiographs’ added value on diagnostic certainty scores were similar between GP and SP. Radiographs added some certainty for the diagnosis OA (mean GP score 68 vs 71, P<0.001; SP 69 vs 75, P<0.001), but not for the diagnosis ‘non-OA’ (GP stable at 23, SP stable at 22). Conclusions: The added value of radiographs in diagnosing knee osteoarthritis was similar for GP and SP in terms of diagnostic indicators and certainty scores. A large part of diagnoses was consistent before and after viewing radiographs. As can be expected, radiographs add diagnostic value in cases where the clinical knee OA diagnosis is uncertain, and radiographs add little when the clinical diagnosis is (fairly) certain. It seemed radiographs made GPs and SPs more certain of diagnosing knee OA, but not of excluding it.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W3017374741 date "2020-04-01" @default.
• W3017374741 modified "2023-10-16" @default.
• W3017374741 title "The added value of radiographs in diagnosing knee osteoarthritis is similar for general practitioner and secondary care physician" @default.
• W3017374741 doi "https://doi.org/10.1016/j.joca.2020.02.065" @default.
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