Concordance analysis of common hand pathology referrals from primary care to plastic surgery: a retrospective cross-sectional study.

Abstract

Hand conditions are commonly referred from primary care to plastic surgery; however, no prior studies have assessed diagnostic concordance between family physicians and plastic surgeons. This study aimed to evaluate the accuracy and agreement of referring diagnoses for common hand pathologies. We conducted a retrospective cross-sectional study of 141 adult referrals from family physicians to plastic surgery for hand conditions at a tertiary care center over a 1-year period. Referrals were classified into five categories: correct, incorrect, missed main diagnosis, missed other diagnoses, and vague. Diagnostic accuracy and concordance were evaluated using descriptive statistics, Cohen's kappa (κ), and Gwet's AC1. Among 141 patients, 142 referring diagnoses and 167 final diagnoses were recorded. Carpal tunnel syndrome (29.9%) and Dupuytren's disease (13.8%) were the most common referrals. Overall diagnostic concordance was substantial (κ = 0.67; 95% confidence interval [CI], 0.58-0.73). Concordance was highest for carpal tunnel syndrome and Dupuytren's disease (both κ = 0.88), and lower for trigger finger (κ = 0.69), ganglions (κ = 0.53), and first carpometacarpal joint osteoarthritis (κ = 0.52). Diagnostic accuracy of family physicians was 70.7%. Most diagnoses were made clinically by the plastic surgeon at the initial consultation. Diagnostic concordance between family physicians and plastic surgeons was substantial. While carpal tunnel syndrome and Dupuytren's disease showed high agreement, lower concordance for other hand conditions highlights opportunities for focused educational tools to improve diagnostic precision in primary care.