[Importance of questioning and physical examination in pediatric clinical diagnosis].
In order to determine the certainty of the nosologic as well as the etiologic diagnosis of a complication that a group of physicians can achieve with the use of the interrogatory and physical examination in solving pediatric cases, a comparative survey was carried out with 36 pediatricians. Three clinical cases were chosen (A, B and C) in three different versions (1 = interrogatory, 2 = interrogatory plus physical examination, and 3 = the same plus clinical laboratory tests). Randomly, the physicians reached a diagnosis in all three cases in any one of its versions. Generally, through interrogatory, 66.6% of the physicians (24/36) reached a nosologic diagnosis, 8.3% (3/26) diagnosed the complication and 41% (15/36) the etiological. Together with the physical examination, the percentages increased to 67.5% (25/ 37), 18.9% (7/37) and 43.2% (16/37), respectively (p < 0.05). In Case A, the main nosologic diagnosis was reached by 71, 90 and 91% of the physicians, V = 1, 2 and 3 (p = ns). In Case B, the main nosologic diagnosis was reached by all of the physicians, and in C, 10, 21 and 90% (p < 0.05) of the physicians, respectively. No differences were found in determining the etiologic diagnosis in versions one and two of the three cases. Differences were found in V3 (p < 0.001). More physicians reached the diagnosis of the complications in Cases A and C. Having previous experience in similar cases allowed for a greater percentage of physicians to reach the main nosologic diagnosis (75%, 18/24 vs. 50%, 6/ 112, p = 0.03). The interrogatory and the physical examinations in pediatrics continue to be a useful tool, allowing for a certain diagnosis in 70% to 100% of the cases of common ambulatory pathology. Previous experience in similar cases is a determining factor in reaching a correct diagnosis.
Rendón-Macías
M E
ME
Departamento de Lactantes, Pediatría Médica, Hospital de Pediatría, Instituto Mexicano del Seguro Social, México, D.F.
Lazcano-Loya
J C
JC
D002983:Clinical Competence; D004927:Escherichia coli Infections; D006192:Haemophilus Infections / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008487:Medical History Taking; D008590:Meningoencephalitis / Q000175:diagnosis; D010372:Pediatrics / Q000379:methods*; D010808:Physical Examination; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis
La importancia del interrogatorio y de la exploración física para el diagnóstico clínico pediátrico.