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Perspectives of primary health care physicians on diagnosing and referring patients with apparent osteolytic lesions on plain X-ray films: a cross-sectional study

Authors Alyami A, Alshomrani Y, Suqaty R, Futtiny S, Alnaqib F, Albarakati M, Alhazmi A

Received 2 August 2015

Accepted for publication 13 January 2016

Published 7 March 2016 Volume 2016:7 Pages 145—151


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Maria Olenick

Peer reviewer comments 3

Editor who approved publication: Dr Anwarul Azim Majumder

Ali Alyami,1,2 Yasser Alshomrani,1,3 Rayyan Suqaty,1 Shaddy Futtiny,1 Faisal Alnaqib,1 Muath Albarakati,1 Ahmad Alhazmi1,4

1King Abdullah International Medical Research Center, Jeddah, 2Department of Orthopaedic Surgery, College of Medicine, King Saud Bin Abdul-Aziz University for Health Science, Jeddah, 3Department of Orthopaedic Surgery, 4Department of Surgery, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia

Background and objectives:
The identification and diagnosis of musculoskeletal symptoms are major challenges for primary care physicians. A lack of clinical suspicion, limited exposure, and referral of patients to nonspecialized centers can delay the management of cases, which in turn can increase morbidity and mortality.
Subjects and methods: Four different sets of X-ray films were shown to 91 primary health care physicians. The first two were normal, whereas the third and fourth showed bone lesions. Participants were asked to indicate the presence of an abnormality, the diagnosis, and the approach to referral if required.
Results: There was a variation in the results for the first two sets of normal X-ray films. Most participants (73.6%) were able to diagnose the first case correctly. However, 73.6% of participants were unable to diagnose the second case correctly. A high percentage of participants (90.1%) were able to detect abnormalities in Cases 3 and 4, with nearly all participants indicating that they would refer patients to centers other than bone oncology centers in the western region of Saudi Arabia if they suspected bone tumors. Only 25.8% of participants were aware of these bone oncology centers.
Conclusion: Physicians in many primary health care centers need practice in reading normal X-ray films to avoid unnecessary referral of patients to specialized medical centers. We recommend the development of a new system for referring patients suspected to have bone tumors to avoid a delay in the management of cases and to decrease morbidity and mortality.

Keywords: primary health care physicians, diagnosis, referral, osteolytic, lesion, X-ray film

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