Inquiry into the diagnostic workup of patients with fever of unknown origin.
BACKGROUND
The utility of algorithms in patients with fever of unknown origin (FUO) has not yet been determined. Before starting a prospective study on the utility of a staged diagnostic protocol in patients with FUO, we performed an inquiry among internists in each university hospital in the Netherlands to obtain insight into their diagnostic approaches to FUO.


METHODS
Nineteen of 24 internists filled out a questionnaire. The first part consisted of a description of a patient with FUO having few potentially diagnostic clues and questions on the work-up of this patient with FUO. In the second part a multiple-choice form had to be filled out specifying the clinical situations in which one would order in general each of the 182 investigations mentioned.


RESULTS
Regarding the first part, a median of 6 (2-16) possible diagnoses was mentioned. Many investigations would be ordered on the basis of this differential diagnosis. Regarding the second part, 38 investigations were ordered as a screening procedure by more than 50% of these internists. A median of 49 investigations was ordered as a screening procedure per internist and 103 investigations on suspicion of a possible diagnosis only.


CONCLUSIONS
Many investigations were used as screening procedures in the diagnostic process of patients with FUO. A two-staged diagnostic protocol was developed based on retrospective analysis of diagnostic management and data from this study. The diagnostic utility of this protocol will be tested in a large prospective multicentre study.
de Kleijn
E M
EM
Department of General Internal Medicine, St. Radboud University Hospital, Nijmegen, Netherlands.
van der Meer
J W
JW
D000465:Algorithms; D005335:Fever of Unknown Origin / Q000175:diagnosis*; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric