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首页> 外文期刊>International Journal of General Medicine >Accuracy of diagnoses predicted from a simple patient questionnaire stratified by the duration of general ambulatory training: an observational study
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Accuracy of diagnoses predicted from a simple patient questionnaire stratified by the duration of general ambulatory training: an observational study

机译：根据普通门诊训练时间分层的简单患者调查表预测的诊断准确性：一项观察性研究

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Purpose: To compare the diagnostic accuracy of diseases predicted from patient responses to a simple questionnaire completed prior to examination by doctors with different levels of ambulatory training in general medicine.Participants and methods: Before patient examination, five trained physicians, four short-term-trained residents, and four untrained residents examined patient responses to a simple questionnaire and then indicated, in rank order according to their subjective confidence level, the diseases they predicted. Final diagnosis was subsequently determined from hospital records by mentor physicians 3 months after the first patient visit. Predicted diseases and final diagnoses were codified using the International Classification of Diseases version 10. A “correct” diagnosis was one where the predicted disease matched the final diagnosis code.Results: A total of 148 patient questionnaires were evaluated. The Herfindahl index was 0.024, indicating a high degree of diversity in final diagnoses. The proportion of correct diagnoses was high in the trained group (96 of 148, 65%; residual analysis, 4.4) and low in the untrained group (56 of 148, 38%; residual analysis, -3.6) (χ2=22.27, P<0.001). In cases of correct diagnosis, the cumulative number of correct diagnoses showed almost no improvement, even when doctors in the three groups predicted ≥4 diseases.Conclusion: Doctors who completed ambulatory training in general medicine while treating a diverse range of diseases accurately predicted diagnosis in 65% of cases from limited written information provided by a simple patient questionnaire, which proved useful for diagnosis. The study also suggests that up to three differential diagnoses are appropriate for diagnostic prediction, while ≥4 differential diagnoses barely improved the diagnostic accuracy, regardless of doctors’ competence in general medicine. If doctors can become able to predict the final diagnosis from limited information, the correct diagnostic outcome may improve and save further consultation hours.
机译：目的：将由患者反应预测的疾病的诊断准确性与由接受过不同水平普通医学训练的医生在检查前完成的简单问卷进行比较。参加者和方法：在患者检查之前，请五位经过培训的医师，四位短期医师训练有素的居民和四名未经训练的居民检查了患者对简单问卷的反应，然后根据他们的主观置信水平按顺序列出了他们所预测的疾病。随后，在首次患者就诊后3个月，由指导医师根据医院记录确定最终诊断。使用《国际疾病分类》第10版对可预测的疾病和最终诊断进行了整理。“正确”的诊断是指所预测的疾病与最终诊断代码相匹配的结果。结果：共评估了148份患者问卷。 Herfindahl指数为0.024，表明最终诊断的高度多样性。正确诊断的比例在训练有素的组中较高（148分之96，占65％;残差分析，4.4），在未经训练的组中正确率较低（148分之56，占38％;残差分析，-3.6）（χ2= 22.27，P <0.001）。在正确诊断的情况下，即使三组医生预测≥4种疾病，正确诊断的累积数也几乎没有改善。结论：在常规医学中完成门诊训练，同时治疗多种疾病的医生准确地预测了疾病的诊断。通过简单的患者问卷提供的有限书面信息中有65％的病例证明对诊断有用。这项研究还表明，多达三项鉴别诊断适合进行诊断预测，而≥4种鉴别诊断几乎不能提高诊断准确性，而与医生在普通医学领域的能力无关。如果医生能够从有限的信息中预测最终诊断，则正确的诊断结果可能会改善并节省更多的咨询时间。

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