[Relative contribution of history-taking, physical examination, and stat laboratory test to diagnosis in chest pain patients].
To evaluate the relative importance of the medical history, physical examination, and stat laboratory tests in diagnosis, twelve general internists recorded their hypotheses (diseases) with subjective probabilities assigned to them after taking the history, and after performing the physical examination, and again after obtaining stat laboratory test results. The resultant hypotheses generated for chest pain patients were compared with the final diagnoses which were determined an average of 7.6 months later. A hypothesis subjectively determined to have the highest probability was shown to agree with the final diagnosis in 71.1% of the patients after taking the history: the physical examination was useful in raising this proportion only by 5.0%. Stat laboratory tests, however, raised the proportion from 63.6% to 81.4% for patients where stat laboratory tests were done. When subjective probabilities were used as a measuring index, earlier hypotheses were correct with an average predictive value of 0.57 after the history-taking, 0.62 after the physical examination, and 0.73 after stat laboratory tests. The average subjective probability after physical examination for a group of patients who subsequently underwent stat laboratory tests was 0.59, while that for a group of patients who did not undergo stat laboratory tests was 0.78. Based on these results test-treatment threshold was estimated to be approximately 0.69. The number of hypotheses were, on the average, 2.48 after the history-taking, 2.35 after the physical examination, and 1.90 after stat laboratory tests. From the stand point of social responsibility and individual patient perspectives quantitative measurement of physicians' predictions should be provided as the basis for assessment of the benefit of high medical technologies.
Fukui
T
T
Department of General Medicine, Saga Medical School.
D002637:Chest Pain / Q000175:diagnosis*; D019411:Clinical Laboratory Techniques; D003327:Coronary Disease / Q000175:diagnosis; D003866:Depressive Disorder / Q000175:diagnosis; D006801:Humans; D008487:Medical History Taking; D009135:Muscular Diseases / Q000175:diagnosis; D009437:Neuralgia / Q000175:diagnosis; D010808:Physical Examination