title: [Prospective study to evaluate diagnostic accuracy in benign anal diseases in primary care].
abstract: OBJECTIVE
  To analyse the diagnostic performance of the primary care (PC) doctor in benign anal diseases.
  
  
  METHODS
  Cross-sectional study including patients referred to our clinic from PC with the diagnosis of clinical conditions pertaining to benign anal diseases between 1st June and 31st December 2007. The diagnosis established by the PC doctor was compared with that of 2 medical specialists in general and digestive diseases surgery.
  
  
  METHODS
  Department of General Surgery and Digestive Diseases. Castellon General Hospital.
  
  
  METHODS
  Patients diagnosed with a benign anal disease in PC and referred to our department.
  
  
  METHODS
  The sensitivity, specificity and kappa index was calculated for each disease.
  
  
  RESULTS
  A total of 105 patients were included. The diagnoses were: 65 haemorrhoids, 13 fissures, 8 fistulas, 7 abscesses, 4 pilonidal cysts, and 8 other diagnoses. A physical examination was carried out on 61 patients and 19 had a rectal examination. In AE, 44 haemorrhoids, 20 fissures, 9 pilonidal cysts were diagnosed and there were 16 other diagnoses. For haemorrhoids the sensitivity was 90.9%, the specificity 59%, and the kappa index was 0.5. For a fistula, it was 43.8%, 98.9% and 0.5, respectively and for a fissure, 15%, 88.2% and 0.04. The physical examination improved all these results.
  
  
  CONCLUSIONS
  The diagnostic performance of benign anal diseases in PC is insufficient. A good physical examination and improved training in these diseases could possibly improve these results.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General de Castellón, Castellón, Spain. davidmartinez@comcas.es
authors.forename: David
authors.initials: D
authors.lastname: Martínez-Ramos
authors.forename: Jesús
authors.initials: J
authors.lastname: Nomdedéu-Guinot
authors.forename: Rafael
authors.initials: R
authors.lastname: Artero-Sempere
authors.forename: Javier
authors.initials: J
authors.lastname: Escrig-Sos
authors.forename: Juan
authors.initials: J
authors.lastname: Gibert-Gerez
authors.forename: Miguel
authors.initials: M
authors.lastname: Alcalde-Sánchez
authors.forename: José Luis
authors.initials: JL
authors.lastname: Salvador-Sanchis