RESUMEN
Introduction: Early disease detection in veterinary care relies on identifying subclinical abnormalities in asymptomatic animals during wellness visits. This study introduces a model designed to distinguish between wellness and other types of veterinary visits. Objectives: The purpose of this study is to validate the use of a visit classification model compared to manual classification of veterinary visits by three board-certified veterinarians. Materials and methods: The algorithm was initially trained using a Gradient Boosting Machine model with a dataset of 11,105 clinical visits from 2012 to 2017 involving 655 animals (85.3% dogs and 14.7% cats) across 544 U.S. veterinary practices. Three validators were tasked with classifying 400 visits, including both wellness and other types of visits, selected randomly from the same database used for initial model training, aiming to maintain consistency and relevance between the training and application phases; visit classifications were subsequently categorized into "wellness" or "other" based on majority consensus among validators to assess the model's performance in identifying wellness visits. Results: The model demonstrated a specificity of 0.94 (95% CI: 0.91 to 0.96), implying its accuracy in distinguishing non-wellness visits. The model had a sensitivity of 0.86 (95% CI: 0.80 to 0.92), indicating its ability to correctly identify wellness visits as compared to the annotations provided by veterinary experts. The balanced accuracy, calculated as 0.90 (95% CI: 0.87 to 0.93), further confirms the model's overall effectiveness. Clinical significance: The model exhibits high specificity and sensitivity, ensuring accurate identification of a high proportion of wellness visits. Overall, this model holds promise for advancing research on preventive care's role in subclinical disease identification, but prospective studies are needed for validation.
RESUMEN
BACKGROUND: Canine life stage is a key factor in parasite prevalence as clinical signs associated with parasitism are more common in pups. In adult dogs, health status and geographical region may also play a role in parasite prevalence. The purpose of this study was to evaluate fecal test results using zinc sulfate flotation by centrifugation combined with fecal antigen testing for hookworms (Ancylostoma spp. Uncinaria stenocephala), ascarids (Toxocara canis, Toxascaris spp., Baylisascaris spp.) and whipworms (Trichuris vulpis) sorted by age, geographical region and veterinary visit type. METHODS: A retrospective sample of intestinal parasite panels submitted to IDEXX Laboratories from 1,626,104 individual dogs were selected from the continental USA from 1 January 2017 to 31 December 2019. These data contain results from fecal exams performed using zinc sulfate flotation by centrifugation paired with coproantigen immunoassay results for hookworms, ascarids, whipworms and Giardia (Fecal Dx® with Giardia coproantigen immunoassay plate). For paired testing, if either the coproantigen assay or flotation test was positive, the sample was considered to be positive. Data were summarized by age category, U.S. Census Bureau geographical region (Northeast, South, Midwest, West) and veterinary visit type. Visit types were subdivided into Wellness Visits and Other Clinical Visits in which a fecal sample was submitted. RESULTS: In dogs presenting for either Wellness Visits or Other Clinical Visits in which Giardia testing was included, Giardia had the highest positivity (combined results for microscopy and coproantigen: 12.2 and 10.8%, respectively), followed by hookworms (combined microscopy and coproantigen: 4.1 and 4.2%, respectively), ascarids (combined microscopy and coproantigen: 2.5 and 1.7%, respectively) and whipworms (combined microscopy and coproantigen: 1.1 and 1.4%, respectively). When all test results were pooled together, pups aged 2-6 months were observed to have the highest proportion of positive results by either microscopy or coproantigen immunoassay regardless of clinical visit type. Parasite positivity varied by geographical region. Regardless of visit type, age or geographical region, the coproantigen method was observed to find a higher proportion of positive test results than microscopy in Giardia, ascarids, hookworms and whipworms. CONCLUSIONS: The Fecal Dx® coproantigen immunoassay combined with the zinc sulfate flotation by centrifugation method uncovers a higher number of positive hookworm, ascarid and whipworm infections than zinc sulfate flotation alone in both pups and adult dogs across all geographical regions of the USA regardless of visit type.
