Ab1623-HPR Clinical Checklists in the Request for Analysis for Profiles of Suspicion as an Improvement of a Referral Tool to Rheumatology

Background: In October 2022, a tool (HRR) was implemented in the Clínico-Malvarrosa health department to assist in the decision to refer to the Rheumatology Service (RS) through the use of blood tests (BT) requested by Primary Care (PC) through 6 enabled clinical profiles, calculating a sensibility of 71,7%, a specificity of 90,8% and a negative predictive value of 95,2%. The diagnosis of inflammatory rheumatic diseases is eminently clinical, and analytical alterations are helpful, but some cases do not suffer from these alterations. In March 2023, clinical checklist-type questions (ChL) were added to the electronic request form (ERF) of PC for each profile, serving as real-time support in the event of a suspicion to detect seronegative patients without an elevation of acute-phase reactants. Objectives: To Evaluate changes in the performance of the HRR after incorporating clinical ChL associated with each analytical profile. Methods: Retrospective cross-sectional study of the review of BT with ChL requested by PC in May 2023. The corresponding ChL questions are established for each profile: For the Inflammatory Arthritis (IA) profile, the 4 recommended questions in GUIPAR-17; for the Psoriasic Arthritis (PsA) profile, the PURE-4 questionary, for Spondyloarthritis (SpA) the agreed questions for the ESPANDE project of our department, based on the ASAS criteria; for Polymialgia Rheumatica the ACR/EULAR 2017 classification criteria; for Raynaud's Phenomenon (RP) two questions to differentiate changes due to erythema pernio: presence of white phase and presence of pruritic lesions on fingers. Finally, the connetive tissue profile, was left with free text. Two laboratory physicians (LP) reviewed the requests and, based on the findings and information provided, prepared interpretative reports recommending referral to the RS or not, and considering a new scenario: patient without analytical alterations, with suspicious completion of ChL, candidate for referral. Results: 274 AS BT were requested by PC: 213 for the IA profile, 35 for SpA, and 26 for PsA. A total of 78 cases were referred to the RS. 64 IA, 7 SpA and 7 PsA cases. 8 cases suggestive of clinical referral but not biochemical were found: 4 in IA (2 were referred, 1 diagnosed with neck pain an another with epicondylitis); 1 in SpA (was referred and diagnosed with chronic back pain); and 3 in PsA (2 are referred, both with Psoriasis diagnosis without PsA). The delay times until the visit with RS were 3.1 ± 3.07 months for IA, 6.13 ± 4.1 for SpA, and 5.1 ± 2.4 for PsA. The diagnostic accuracy rate was 28.9% for IA, 6.5% for SpA, and 12.5% for PsA. Conclusion: The incorporation of ChL into the HRR is accessible and facilitates the decision to refer to the RS by the PC physicians. 8 cases suggestive of referral based on clinical profile without biochemical alterations were detected out of 274 requested BT, which does not seem to affect the previously calculated performance. The accuracy rate has been low, attributable to the novelty of the HRR and inadequacies in the requests. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.