Med Decis Making - Correlates of diagnostic accuracy in patients with nonspecific complaints.

Tópicos

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Resumo

JECTIVE: To investigate diagnostic accuracy in patient histories involving nonspecific complaints and the extent to which characteristics of physicians and structural properties of patient histories are associated with accuracy.METHODS: Six histories of patients presenting to the emergency department (ED) with nonspecific complaints were provided to 112 physicians: 36 ED physicians, 50 internists, and 26 family practitioners. Physicians listed the 3 most likely diagnoses for each history and indicated which cue(s) they considered crucial. Four weeks later, a subset of 20 physicians diagnosed the same 6 histories again. For each history, experts had previously determined the correct diagnoses and the diagnostic cues.RESULTS: Accuracy ranged from 14% to 64% correct diagnoses (correct diagnosis listed as the most likely) and from 29% to 87% correct differential diagnoses (correct diagnosis listed in the differential). Acute care physicians (ED physicians and internists) included the correct diagnosis in the differential in, on average, 3.4 histories, relative to 2.6 for the family practitioners (P = 0.001, d = .75). Diagnostic performance was fairly reliable (r = .61, P < 0.001). Clinical experience was negatively correlated with diagnostic accuracy (r = -.25, P = 0.008). Two structural properties of patient histories-cue consensus and cue substitutability-were significantly associated with diagnostic accuracy, whereas case difficulty was not. Finally, prevalence of diagnosis also proved significantly correlated with accuracy.CONCLUSIONS: Average diagnostic accuracy in cases with nonspecific complaints far exceeds chance performance, and accuracy varies with medical specialty. Analyzing cue properties in patient histories can help shed light on determinants of diagnostic performance and thus suggest ways to enhance physicians' ability to accurately diagnose cases with nonspecific complaints.

Resumo Limpo

jectiv investig diagnost accuraci patient histori involv nonspecif complaint extent characterist physician structur properti patient histori associ accuracymethod six histori patient present emerg depart ed nonspecif complaint provid physician ed physician internist famili practition physician list like diagnos histori indic cue consid crucial four week later subset physician diagnos histori histori expert previous determin correct diagnos diagnost cuesresult accuraci rang correct diagnos correct diagnosi list like correct differenti diagnos correct diagnosi list differenti acut care physician ed physician internist includ correct diagnosi differenti averag histori relat famili practition p d diagnost perform fair reliabl r p clinic experi negat correl diagnost accuraci r p two structur properti patient historiescu consensus cue substitutabilitywer signific associ diagnost accuraci wherea case difficulti final preval diagnosi also prove signific correl accuracyconclus averag diagnost accuraci case nonspecif complaint far exceed chanc perform accuraci vari medic specialti analyz cue properti patient histori can help shed light determin diagnost perform thus suggest way enhanc physician abil accur diagnos case nonspecif complaint

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