title: Evaluation of farmers' diagnostic performance for detection of diarrhoea in nursery pigs using digital pictures of faecal pools.
abstract: BACKGROUND
  Over-consumption of antibiotics in the pig industry is of concern in relation to antimicrobial resistance. False positive disease diagnosis may result in the treatment of healthy animals. In Denmark, diarrhoea is the most common cause of antibiotic treatment in pigs. Farm personnel are not professional clinicians, which could result in inappropriate antibiotic treatments of diarrhoea.The primary objectives of this pilot study using digital pictures of faecal pools was to evaluate farmers' diagnostic performance in the assessment of faecal consistency in nursery pigs and to investigate the effect of different co-variables, including practical experience. A secondary objective was to compare the diagnostic performance of farmers with that of veterinarians.At a pig congress, observers (farm personnel and veterinarians) working professionally with pigs participated in a faecal consistency test consisting of 16 pictures of faecal pools (eight diarrhoeic and eight non-diarrhoeic). The faecal pools had previously been collected and subjected to faecal dry matter determination. The true status of the faecal pools was determined by the faecal dry matter content (diarrhoea: faecal dry matter ≤ 18%). The true status was used to evaluate the farmers' and veterinarians' diagnostic performance.
  
  
  RESULTS
  A total of 119 farmers and 18 veterinarians were included in the statistical analysis. For the farmers, the mean proportion of faecal pools assessed as diarrhoeic was 0.48, the mean proportion of correctly classified faecal pools was 0.84, the mean diagnostic sensitivity was 0.83 and the mean diagnostic specificity was 0.86. Farmers with less than four years of practical experience detected clinical diarrhoea more accurately than farmers with more than four years of practical experience (p < 0.05). No significantly differences between farmers and veterinarians was observed (p > 0.20).
  
  
  CONCLUSIONS
  The results, using digital pictures of faecal pools, suggest that farmers and veterinarians have similar diagnostic performance in relation to diarrhoea. False positive classification of non-diarrhoeic pigs appears to be a larger problem than false negative classification of diarrhoeic pigs under Danish conditions. If these results can be confirmed under practical conditions, training in, and validation of, clinical diagnoses may be an important factor in reducing antibiotic consumption in the pig industry.
authors.affiliation: HERD - Centre for Herd-oriented Education, Research and Development, Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Groennegaardsvej 2, Frederiksberg, DK-1870 Copenhagen, Denmark. kpe@lf.dk.
authors.forename: Ken S
authors.initials: KS
authors.lastname: Pedersen
authors.forename: Anne M
authors.initials: AM
authors.lastname: Strunz
mesh_terms: D000818:Animals; D003967:Diarrhea / Q000175:diagnosis / Q000473:pathology / Q000662:veterinary*; D005243:Feces; D007722:Health Knowledge, Attitudes, Practice; D010865:Pilot Projects; D013552:Swine; D013553:Swine Diseases / Q000175:diagnosis* / Q000473:pathology; D018634:Veterinarians / Q000592:standards; D014730:Veterinary Medicine / Q000592:standards