title: First clinical judgment by primary care physicians distinguishes well between nonorganic and organic causes of abdominal or chest pain.
abstract: OBJECTIVE
  To evaluate the accuracy of a preliminary diagnosis based solely on patient history and physical examination in medical outpatients with abdominal or chest pain.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  General medical outpatient clinic in a university teaching hospital.
  
  
  METHODS
  One hundred ninety new, consecutive patients with a mean age of 44 years (SD = 14 years, range 30-58 years) with a main complaint of abdominal or chest pain.
  
  
  RESULTS
  The preliminary diagnosis, established on the basis of patient history and physical examination, was compared with a final diagnosis, obtained after workup at completion of the chart. A nonorganic cause was established in 66 (59%) of 112 patients with abdominal pain and in 65 (83%) of 78 with chest pain. The preliminary diagnosis of "nonorganic" versus "organic" causes was correct in 79% of patients with abdominal pain and in 88% of patients with chest pain. An "undoubted" preliminary diagnosis predicted a correct assessment in all patients with abdominal pain and in all but one patient with chest pain. Overall, only 4 patients (3%) were initially incorrectly diagnosed as having a nonorganic cause of pain rather than an organic cause. In addition, final nonorganic diagnosis (n = 131) was compared with long-term follow-up by obtaining information from patients and, if necessary, from treating physicians. Follow-up information, obtained for 71% of these patients after a mean of 29 months (range 18-56 months) identified three other patients that had been misdiagnosed as having abdominal pain of nonorganic causes. Compared with follow-up, the diagnostic accuracy for nonorganic abdominal and chest pain at chart completion was 93% and 98%, respectively.
  
  
  CONCLUSIONS
  A preliminary diagnosis of nonorganic versus organic abdominal or chest pain based on patient history and physical examination proved remarkably reliable. Accuracy was almost complete in patients with an "undoubted" preliminary diagnosis, suggesting that watchful waiting can be recommended in such cases.
authors.affiliation: Medical Outpatient Clinic, Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Martina
authors.forename: B
authors.initials: B
authors.lastname: Bucheli
authors.forename: M
authors.initials: M
authors.lastname: Stotz
authors.forename: E
authors.initials: E
authors.lastname: Battegay
authors.forename: N
authors.initials: N
authors.lastname: Gyr
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D002637:Chest Pain / Q000209:etiology*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010045:Outpatients; D010808:Physical Examination; D010821:Physicians, Family; D011446:Prospective Studies; D012680:Sensitivity and Specificity