title: Prospective analysis of clinician accuracy in the diagnosis of benign anorrectal pathology: the value of clinical information.
abstract: OBJECTIVE
  the prevalence of anorectal disorders in general population is high. The aim of this study was to analyze the influence of clinical symptoms on diagnostic accuracy for benign anorectal pathology among different specialists and evaluate the relationship between diagnostic accuracy and years of professional experience.
  
  
  METHODS
  seven typical cases were selected. In a first interview, participants were shown images and asked to make a diagnosis. Afterwards, images with additional information (clinical symptoms) were used. Two groups (group 1 = general surgeons and group 2 = medical specialists who attended emergency department) completed both phases of the study to analyze the influence of clinical symptoms on the final diagnosis.
  
  
  RESULTS
  forty four specialists were interviewed. The percentage of participants making a correct diagnosis in groups 1 and 2, respectively, was as follows: case 1 (perianal abscess): 100 vs. 80.6%, (p = 0.157); case 2 (fissure): 92.3 vs. 51.6% (p = 0.015); case 3 (thrombosed hemorrhoid): 92.3 vs. 74.2% (p = 0.321); case 4 (anal condyloma): 100 vs. 87.1% (p = 0.302); case 5 (rectal prolapse): 100 vs. 83.9% (p = 0.301); case 6 (prolapsed hemorrhoid): 92.3 vs. 29% (p = 0.001), and case 7 (fistula): 100 vs. 67.7% (p = 0.021). There were significant differences in the number of correctly diagnosed cases between groups (p < 0.001). Information about clinical symptoms significantly increased overall and specific accuracy. There was no correlation between experience and accuracy.
  
  
  CONCLUSIONS
  clinical symptoms are important for diagnostic accuracy in anorectal pathology. Training in anorectal pathology in medical specialists is warranted.
authors.affiliation: Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Jimeno
authors.forename: Helena
authors.initials: H
authors.lastname: Vallverdú
authors.forename: Jaume
authors.initials: J
authors.lastname: Tubella
authors.forename: Cristina
authors.initials: C
authors.lastname: Sánchez-Pradell
authors.forename: Jordi
authors.initials: J
authors.lastname: Comajuncosas
authors.forename: Rolando
authors.initials: R
authors.lastname: Orbeal
authors.forename: Judit
authors.initials: J
authors.lastname: Hermoso
authors.forename: Pere
authors.initials: P
authors.lastname: Gris
authors.forename: José Luis
authors.initials: JL
authors.lastname: López-Negre
authors.forename: Joan
authors.initials: J
authors.lastname: Urgellés
authors.forename: David
authors.initials: D
authors.lastname: Parés
mesh_terms: D000038:Abscess / Q000175:diagnosis; D001004:Anus Diseases / Q000175:diagnosis* / Q000473:pathology; D002983:Clinical Competence; D005401:Fissure in Ano / Q000175:diagnosis; D006484:Hemorrhoids / Q000175:diagnosis; D006801:Humans; D011446:Prospective Studies; D012002:Rectal Diseases / Q000175:diagnosis* / Q000473:pathology; D012005:Rectal Prolapse / Q000175:diagnosis; D013038:Specialization