Population screening for coeliac disease in primary care by district nurses using a rapid antibody test: diagnostic accuracy and feasibility study.
OBJECTIVE
To evaluate the feasibility and diagnostic accuracy of screening for coeliac disease by rapid detection of IgA antibodies to tissue transglutaminase performed in primary care.


METHODS
District nurses screened 6 year old children using rapid antibody testing of finger prick blood. They also collected capillary blood samples for laboratory determination of IgA and IgG antibodies to endomysium and IgA antibodies to tissue transglutaminase. Children with positive rapid test results were directly sent for biopsy of the small intestine. Setting Primary care in Jász-Nagykun-Szolnok county, Hungary.


METHODS
2690 children (77% of 6 year olds living in the county) and 120 nurses.


METHODS
Positivity for antibodies to endomysium or transglutaminase in the laboratory and coeliac disease confirmed at biopsy.


RESULTS
37 children (1.4%, 95% confidence interval 0.9% to 1.8%) had biopsy confirmed coeliac disease. Only five of these children had been diagnosed clinically before screening. Rapid testing had a 78.1% sensitivity (70.0% to 89.3%) and 100% specificity (88.4% to 100%) for a final diagnosis of coeliac disease by biopsy. Sensitivity was 65.1% (50.2% to 77.6%) and specificity was 100% (99.8% to 100%) compared with combined results of IgA and IgG laboratory tests. Trained laboratory workers detected 30 of the 31 newly diagnosed IgA competent patients with the rapid test kit used blindly. Median time to biopsy after a positive rapid test result was significantly shorter (20 days, range 4-148) than after a positive laboratory result (142 days, 70-256; P<0.001). Children with coeliac disease detected at screening were smaller and had worse health status than their peers but they improved on a gluten-free diet.


CONCLUSIONS
A simple rapid antibody test enabled primary care nurses to detect patients with coeliac disease in the community who were not picked up in clinical care. Extra training is needed to improve sensitivity.
Department of Paediatrics, Medical and Health Science Centre, University of Debrecen, 4032 Debrecen, Hungary.
Ilma R
IR
Korponay-Szabó
Katalin
K
Szabados
Jánosné
J
Pusztai
Katalin
K
Uhrin
Eva
E
Ludmány
Eva
E
Nemes
Katri
K
Kaukinen
Anikó
A
Kapitány
Lotta
L
Koskinen
Sándor
S
Sipka
Anikó
A
Imre
Markku
M
Mäki
D000906:Antibodies / Q000097:blood*; D002446:Celiac Disease / Q000191:economics / Q000451:nursing / Q000517:prevention & control*; D002648:Child; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000592:standards; D003152:Community Health Nursing / Q000191:economics / Q000592:standards*; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007159:Immunologic Tests / Q000191:economics / Q000379:methods / Q000592:standards; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
D000906:Antibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G