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Presentation of respiratory symptoms prior to diagnosis in general practice: a case-control study examining free text and morbidity codes

Hayward, Richard A; Chen, Ying; Croft, Peter; Jordan, Kelvin

Presentation of respiratory symptoms prior to diagnosis in general practice: a case-control study examining free text and morbidity codes Thumbnail


Authors

Richard A Hayward

Ying Chen

Peter Croft



Abstract

OBJECTIVE: General practitioners can record patients' presenting symptoms by using a code or free text. We compared breathlessness and wheeze symptom codes and free text recorded prior to diagnosis of ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and asthma. DESIGN: A case-control study. SETTING: 11 general practices in North Staffordshire, UK, contributing to the Consultations in Primary Care Archive consultation database. PARTICIPANTS: Cases with an incident diagnosis of IHD, COPD or asthma in 2010 were matched to controls (four per case) with no such diagnosis. All prior consultations with codes for breathlessness or wheeze symptoms between 2004 and 2010 were identified. Free text of cases and controls were also searched for mention of these symptoms. RESULTS: 592 cases were identified, 194 (33%) with IHD, 182 (31%) with COPD and 216 (37%) with asthma. 148 (25%) cases and 125 (5%) controls had a prior coded consultation for breathlessness. Prevalence of a prior coded symptom of breathlessness or wheeze was 30% in cases, 6% in controls. Median time from first coded symptom to diagnosis among cases was 57 weeks. After adding symptoms recorded in text, prevalence rose to 62% in cases and 25% in controls. Median time from first recorded symptom increased to 144 weeks. The associations between diagnosis of cases and prior symptom codes was strong IHD relative risk ratio (RRR) 3.21 (2.15 to 4.79); COPD RRR 9.56 (6.74 to 13.60); asthma RRR 10.30 (7.17 to 14.90). CONCLUSIONS: There is an association between IHD, COPD and asthma diagnosis and earlier consultation for respiratory symptoms. Symptoms are often noted in free text by GPs long before they are coded. Free text searching may aid investigation of early presentation of long-term conditions using GP databases, and may be an important direction for future research.

Journal Article Type Article
Acceptance Date Mar 4, 2015
Online Publication Date Jun 12, 2015
Publication Date Jun 12, 2015
Publicly Available Date Mar 28, 2024
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 5
Issue 6
Article Number e007355
DOI https://doi.org/10.1136/bmjopen-2014-007355
Publisher URL http://www.bmj.com/content/347/bmj.f5555

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