sj-docx-1-imj-10.1177_10815589241235663 – Supplemental material for Inpatient thrombophilia workup; does hematology consult prevent unnecessary testing?

Supplemental material, sj-docx-1-imj-10.1177_10815589241235663 for Inpatient thrombophilia workup; does hematology consult prevent unnecessary testing? by Zackary Anderson, Mohammed Ahsan, Carlos Aguirre, Michele Ramirez and Keegan Plowman in Journal of Investigative Medicine</p

COPD Underdiagnosis and Misdiagnosis in a High-Risk Primary Care Population in Four Latin American Countries. A Key to Enhance Disease Diagnosis: The PUMA Study

<div><p>Background</p><p>Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay.</p><p>Objectives</p><p>To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting.</p><p>Methods</p><p>COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC) <0.70 and the lower limit of normal (LLN). Prior diagnosis was self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Those patients with spirometric COPD were considered to have correct prior diagnosis, while those without spirometric criteria had misdiagnosis. Individuals with spirometric criteria without previous diagnosis were considered as underdiagnosed.</p><p>Results</p><p>1,743 patients were interviewed, 1,540 completed spirometry, 309 (post-BD FEV₁/FVC <0.70) and 226 (LLN) had COPD. Underdiagnosis using post-BD FEV₁/FVC <0.70 was 77% and 73% by LLN. Overall, 102 patients had a prior COPD diagnosis, 71/102 patients (69.6%) had a prior correct diagnosis and 31/102 (30.4%) had a misdiagnosis defined by post-BD FEV₁/FVC ≥0.70. Underdiagnosis was associated with higher body mass index (≥30 kg/m²), milder airway obstruction (GOLD I–II), black skin color, absence of dyspnea, wheezing, no history of exacerbations or hospitalizations in the past-year. Those not visiting a doctor in the last year or only visiting a GP had more risk of underdiagnosis. COPD underdiagnosis (65.8%) and misdiagnosis (26.4%) were less prevalent in those with previous spirometry.</p><p>Conclusions</p><p>COPD underdiagnosis is a major problem in primary care. Availability of spirometry should be a priority in this setting.</p></div

Logistic regression models to identify factors associated to COPD underdiagnosis according to different criteria.

<p>Logistic regression models to identify factors associated to COPD underdiagnosis according to different criteria.</p

Prevalence ratios for underdiagnosis according to type of physician visited in past year, by COPD criteria: A) post-BD FEV₁/FVC<0.70; and B) LLN.

<p>Prevalence ratios for underdiagnosis according to type of physician visited in past year, by COPD criteria: A) post-BD FEV₁/FVC<0.70; and B) LLN.</p

Proportion of underdiagnosis among those patients with spirometric diagnosis of COPD by post-BD FEV₁/FVC <0.70, and correct prior diagnosis or misdiagnosis among those patients with previous COPD medical diagnosis.

<p>Proportion of underdiagnosis among those patients with spirometric diagnosis of COPD by post-BD FEV₁/FVC <0.70, and correct prior diagnosis or misdiagnosis among those patients with previous COPD medical diagnosis.</p

Proportion of COPD underdiagnosis according to different criteria (post-BD FEV₁/FVC <0.70 and LLN), total and by country.

<p>P-values for the comparison of underdiagnosis by Fixed ratio and the LLN criteria: Uruguay p = 0.73; Venezuela p = 0.57; Colombia p = 0.78; Argentina p = 0.42; Total p = 0.33.</p

Sample description according to selected variables, prevalence of COPD (medical diagnosis, post-BD FEV₁/FVC <0.70 and LLN criteria) and underdiagnosis proportion of COPD (fixed ratio and LLN criteria).

<p>Sample description according to selected variables, prevalence of COPD (medical diagnosis, post-BD FEV₁/FVC <0.70 and LLN criteria) and underdiagnosis proportion of COPD (fixed ratio and LLN criteria).</p

Theoretical PPVs and NPV values vs fascioliasis prevalence.

<p>Curves show the expected PPVs (continuous line) and NPV (dotted line) values in low (below 1%), medium (between 1% and 10%) or high (above 10%) prevalence scenarios (expressed in vertical lines) in Huacullani (A) and Cajamarca (B).</p

MM3-COPRO ELISA and intensity of <i>Fasciola hepatica</i> infection in the low burden group of Huacullani.

<p>Data points represent the mean absorbance at 492 nm from egg positive children from Huacullani. epg represents the egg count per gram of feces. The dotted line represents the cut-off value 0.097 units of OD at 492 nm.</p

MM3-COPRO ELISA in feces from children (n = 436) from Huacullani (Northern Bolivian Altiplano).

<p>Data points represent the mean absorbance at 492 nm obtained from three replicates of each sample tested. The dotted line represents the cut-off value 0.097 units of OD at 492 nm.</p