Pointers to earlier diagnosis of endometriosis

a nested case-control study using primary care electronic health records

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Abstract

Background Endometriosis is a condition with relatively non-specific symptoms and in some cases a long time from first symptom presentation to diagnosis. Aim We aimed to develop and test new composite pointers to a diagnosis of endometriosis in primary care electronic records. Design & Setting Nested case-control study using the Practice Team Information database of anonymised primary care electronic health records from Scotland. Data from 366 cases of endometriosis between 1994 and 2010 and two sets of age and GP practice matched controls (a) 1453 randomly selected women (b) 610 women whose records contained codes indicating consultation for gynaecological symptoms. Methods Composite pointers comprised patterns of symptoms, prescribing or investigations, in combination or over time. We used conditional logistic regression to examine the presence of both new and established pointers during the three years before diagnosis of endometriosis and identify when they appeared. Results Several composite pointers were strongly predictive of endometriosis: including pain and menstrual symptoms occurring within the same year (OR 6.5, 95% CI 3.9 to 10.6) and lower gastrointestinal symptoms occurring within 90 days of gynaecological pain (OR 6.1, 95% CI 3.6 to 10.6). While the association of infertility with endometriosis was only detectable in the year before diagnosis, several pain-related features were associated with endometriosis several years earlier. Conclusions We have identified useful composite pointers to a diagnosis of endometriosis in GP records. Some of these were present several years before the diagnosis and may be valuable targets for diagnostic support systems.
Original languageEnglish
Pages (from-to)e816-e823
Number of pages8
JournalThe British Journal of General Practice
Volume67
Issue number665
Early online date6 Nov 2017
DOIs
Publication statusPublished - Dec 2017

Fingerprint

Electronic Health Records
Endometriosis
Case-Control Studies
Early Diagnosis
Primary Health Care
Pain
Scotland
Referral and Consultation
Databases

Keywords

  • Endometriosis
  • Diagnosis
  • Primary Care
  • Electronic Health Records

Cite this

@article{59ff3585f98540deab8ea735713bee09,
title = "Pointers to earlier diagnosis of endometriosis: a nested case-control study using primary care electronic health records",
abstract = "Background Endometriosis is a condition with relatively non-specific symptoms and in some cases a long time from first symptom presentation to diagnosis. Aim We aimed to develop and test new composite pointers to a diagnosis of endometriosis in primary care electronic records. Design & Setting Nested case-control study using the Practice Team Information database of anonymised primary care electronic health records from Scotland. Data from 366 cases of endometriosis between 1994 and 2010 and two sets of age and GP practice matched controls (a) 1453 randomly selected women (b) 610 women whose records contained codes indicating consultation for gynaecological symptoms. Methods Composite pointers comprised patterns of symptoms, prescribing or investigations, in combination or over time. We used conditional logistic regression to examine the presence of both new and established pointers during the three years before diagnosis of endometriosis and identify when they appeared. Results Several composite pointers were strongly predictive of endometriosis: including pain and menstrual symptoms occurring within the same year (OR 6.5, 95{\%} CI 3.9 to 10.6) and lower gastrointestinal symptoms occurring within 90 days of gynaecological pain (OR 6.1, 95{\%} CI 3.6 to 10.6). While the association of infertility with endometriosis was only detectable in the year before diagnosis, several pain-related features were associated with endometriosis several years earlier. Conclusions We have identified useful composite pointers to a diagnosis of endometriosis in GP records. Some of these were present several years before the diagnosis and may be valuable targets for diagnostic support systems.",
keywords = "Endometriosis, Diagnosis, Primary Care, Electronic Health Records",
author = "Christopher Burton and Lisa Iversen and Sohinee Bhattacharya and Dolapo Ayansina and Lucky Saraswat and Derek Sleeman",
note = "Acknowledgments: We wish to thank the expert clinicians and representatives of Endometriosis UK for their interviews. Funding: This study was funded by the Chief Scientist Office of NHS Scotland through its first health informatics call (reference HICG/1/25). The funder played no role in conducting the research or in writing the paper.",
year = "2017",
month = "12",
doi = "10.3399/bjgp17X693497",
language = "English",
volume = "67",
pages = "e816--e823",
journal = "The British Journal of General Practice",
issn = "0960-1643",
publisher = "Royal College of General Practitioners",
number = "665",

}

TY - JOUR

T1 - Pointers to earlier diagnosis of endometriosis

T2 - a nested case-control study using primary care electronic health records

AU - Burton, Christopher

AU - Iversen, Lisa

AU - Bhattacharya, Sohinee

AU - Ayansina, Dolapo

AU - Saraswat, Lucky

AU - Sleeman, Derek

N1 - Acknowledgments: We wish to thank the expert clinicians and representatives of Endometriosis UK for their interviews. Funding: This study was funded by the Chief Scientist Office of NHS Scotland through its first health informatics call (reference HICG/1/25). The funder played no role in conducting the research or in writing the paper.

PY - 2017/12

Y1 - 2017/12

N2 - Background Endometriosis is a condition with relatively non-specific symptoms and in some cases a long time from first symptom presentation to diagnosis. Aim We aimed to develop and test new composite pointers to a diagnosis of endometriosis in primary care electronic records. Design & Setting Nested case-control study using the Practice Team Information database of anonymised primary care electronic health records from Scotland. Data from 366 cases of endometriosis between 1994 and 2010 and two sets of age and GP practice matched controls (a) 1453 randomly selected women (b) 610 women whose records contained codes indicating consultation for gynaecological symptoms. Methods Composite pointers comprised patterns of symptoms, prescribing or investigations, in combination or over time. We used conditional logistic regression to examine the presence of both new and established pointers during the three years before diagnosis of endometriosis and identify when they appeared. Results Several composite pointers were strongly predictive of endometriosis: including pain and menstrual symptoms occurring within the same year (OR 6.5, 95% CI 3.9 to 10.6) and lower gastrointestinal symptoms occurring within 90 days of gynaecological pain (OR 6.1, 95% CI 3.6 to 10.6). While the association of infertility with endometriosis was only detectable in the year before diagnosis, several pain-related features were associated with endometriosis several years earlier. Conclusions We have identified useful composite pointers to a diagnosis of endometriosis in GP records. Some of these were present several years before the diagnosis and may be valuable targets for diagnostic support systems.

AB - Background Endometriosis is a condition with relatively non-specific symptoms and in some cases a long time from first symptom presentation to diagnosis. Aim We aimed to develop and test new composite pointers to a diagnosis of endometriosis in primary care electronic records. Design & Setting Nested case-control study using the Practice Team Information database of anonymised primary care electronic health records from Scotland. Data from 366 cases of endometriosis between 1994 and 2010 and two sets of age and GP practice matched controls (a) 1453 randomly selected women (b) 610 women whose records contained codes indicating consultation for gynaecological symptoms. Methods Composite pointers comprised patterns of symptoms, prescribing or investigations, in combination or over time. We used conditional logistic regression to examine the presence of both new and established pointers during the three years before diagnosis of endometriosis and identify when they appeared. Results Several composite pointers were strongly predictive of endometriosis: including pain and menstrual symptoms occurring within the same year (OR 6.5, 95% CI 3.9 to 10.6) and lower gastrointestinal symptoms occurring within 90 days of gynaecological pain (OR 6.1, 95% CI 3.6 to 10.6). While the association of infertility with endometriosis was only detectable in the year before diagnosis, several pain-related features were associated with endometriosis several years earlier. Conclusions We have identified useful composite pointers to a diagnosis of endometriosis in GP records. Some of these were present several years before the diagnosis and may be valuable targets for diagnostic support systems.

KW - Endometriosis

KW - Diagnosis

KW - Primary Care

KW - Electronic Health Records

U2 - 10.3399/bjgp17X693497

DO - 10.3399/bjgp17X693497

M3 - Article

VL - 67

SP - e816-e823

JO - The British Journal of General Practice

JF - The British Journal of General Practice

SN - 0960-1643

IS - 665

ER -