Gout Flare Prediction Tool Tested in ED Setting

Investigators seeking to refine and test the capabilities of a medical record alert system to diagnose flares of gout found its sensitivity and specificity “reasonable” but its positive predictive value was just 47%, according to their report in Arthritis Care & Research.

Patients with acute flares of gout “represent a typically underresourced and understudied population,” who often visit an emergency department (ED) for care the authors wrote. “A key limitation for gout research in the ED is the timely ability to identify acute gout patients.”

The gout flare alert used electronic medical record (EMR) data from ED nursing notes and “was triggered by the term ‘gout’ preceding past medical history in the chief complaint, the term ‘gout’ and a musculoskeletal problem in the chief complaint, or the term ‘gout’ in the problem list and a musculoskeletal chief complaint,” they noted. The team conducted manual review of medical records to assess the presence or absence of gout to validate the alert system’s,
“using adjudicated expert consensus as the gold standard.”

The investigators analyzed 202 patient records from 2 EDs at university-based medical centers in January 2020; the gout flare alert identified 57 of these patients as possible cases of acute gout, while 145 were identified by other means.

“The gout flare alert's positive predictive value was 47% (95% CI [34–60%]), negative predictive value was 94% (95% CI [90–98%]), sensitivity was 75% (95% CI [61–89%]), and specificity was 82% (95% CI [76–88%]),” the authors wrote. “The diagnostic properties were similar at both institutions.”

They concluded, “An electronic gout flare alert may help enable the conduct of gout research in the ED setting.”

—Rebecca Mashaw

Reference:

Jackson LE, Annapureddy N, Hansen ME, et al. Development and validation of an emergency department electronic medical record gout flare alert. Arthritis Care Res. Published online

November 21, 2022. https://doi.org/10.1002/acr.25061