title: A method for rating charts to identify and classify patients with medically unexplained symptoms.
abstract: BACKGROUND
  As part of conducting a randomized control trial (RCT) to treat chronically high utilizing patients with medically unexplained symptoms (MUS), we developed the chart rating method reported here to identify and classify MUS subjects.
  
  
  METHODS
  Intended at this point only as a research tool, the method is comprehensive, uses explicit guidelines, and requires clinician raters. It distinguishes primary organic disease patients from those with primary MUS, quantifies medical comorbidities in primary MUS patients, and also distinguishes subgroups among MUS patients that we call somatization (resembles DSM-IV somatoform disorders) and minor acute illness (MAI) which differs from DSM-IV somatoform definitions. Scoring rules are used to generate the diagnoses above. The rules may be set according to the investigator's needs, from highly sensitive to highly specific.
  
  
  RESULTS
  We found high levels of agreement with the gold standard for MUS vs. organic disease (97.6%) and among raters for the key individual chart elements rated (92-96%). The method identified 206 MUS subjects and the extent of their medical comorbidities for entry into a RCT. It also identified somatization and MAI; the latter supports the validity of this newly reported MAI syndrome.
  
  
  CONCLUSIONS
  We concluded that this method offered research potential for identifying MUS patients, for quantifying their medical comorbidities, and for classifying MUS subgroups.
authors.affiliation: Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA. robet.smity@ht.msu.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Smith
authors.forename: Elie
authors.initials: E
authors.lastname: Korban
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kanj
authors.forename: Robert
authors.initials: R
authors.lastname: Haddad
authors.forename: Judith S
authors.initials: JS
authors.lastname: Lyles
authors.forename: Catherine
authors.initials: C
authors.lastname: Lein
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Gardiner
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hodges
authors.forename: Francesca C
authors.initials: FC
authors.lastname: Dwamena
authors.forename: John
authors.initials: J
authors.lastname: Coffey
authors.forename: Clare
authors.initials: C
authors.lastname: Collins
mesh_terms: D015897:Comorbidity; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005189:False Positive Reactions; D006304:Health Status; D006801:Humans; D008487:Medical History Taking; D008499:Medical Records; D015588:Observer Variation; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D011602:Psychophysiologic Disorders / Q000145:classification* / Q000175:diagnosis*