ACURÁCIA DA AVALIAÇÃO DA CONJUNTIVA PALPEBRAL NO DIAGNÓSTICO DE ANEMIA E SUA VARIAÇÃO COM O GRAU DE EXPERIÊNCIA CLÍNICA NO HOSPITAL UNIVERSITÁRIO LAURO WANDERLEY

Abstract

Anemia symptoms are quite nonspecific, marked mainly by pallor, best evaluated in mucosa, especially the palpebral conjunctiva. However, this semiological finding may have other etiologies and generally brings low agreement between evaluators, with no consensus in the literature for improved accuracy in more experienced professionals. OBJECTIVE: The main objective of this study is to evaluate the accuracy of conjunctival pallor ectoscopy for the diagnosis of anemia and its variation with the clinical experience of the examiner. METHODOLOGY: Observational, cross-sectional, individual and analytical study. A total of 54 patients had their palpebral conjunctiva evaluated by a group of interns, residents and/or specialists, in addition to the medical admission record. Hemoglobin was also assessed, used as the gold standard to anemia diagnosis. For each group of examiners, the accuracy, sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratios of the mucosal examination were calculated. Agreement between groups was also evaluated using the linearly weighted Kappa coefficient. In addition, evaluating the association of pallor severity with hemoglobin level, Kruskal-Wallis test was applied to each group. Significance for all tests was set at 5%, with p value < 0.05 statistically significant. Analyzes were performed using the Jamovi 2.2.5 statistical software. RESULTS: The accuracy in the diagnosis of anemia for the groups of interns, residents, specialists and admission records was respectively 67.4% (95% CI 52.5-80.1%); 66.7% (95% CI 49-81.4%); 61.1% (95% CI 43.5-76.9%); 60.5% (95% CI 43.4-76%). Agreement between groups was slight for most comparisons, being moderate between residents and admission records, but non-existent between residents and specialists. There was statistically significant association between pallor and hemoglobin levels only in the interns group. CONCLUSION: The accuracy of conjunctival pallor ectoscopy for the diagnosis of anemia was reasonable, consistent with other studies, and there was no statistically significant difference between the diagnostic tests, showing, within the limitations of the study, that clinical experience does not influence the palpebral conjunctiva evaluation in this hospital.