title: Factors influencing the diagnostic accuracy and management in acute surgical patients.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy (DA) in acute surgical patients admitted to a District General Hospital.
  
  
  METHODS
  The case notes of all acute surgical patients admitted under the surgical team for a period of two weeks were reviewed for the data pertaining to the admission diagnoses, relevant investigations and final diagnoses confirmed by either surgery or various other diagnostic modalities. The diagnostic pathway was recorded from the source of referral [general practitioner (GP), A and E, in-patient] to the correct final diagnosis by the surgical team.
  
  
  RESULTS
  Forty-one patients (23 males) with acute surgical admissions during two weeks of study period were evaluated. The mean age of study group was 61.05 ± 23.24 years. There were 111 patient-doctor encounters. Final correct diagnosis was achieved in 85.4% patients. The DA was 46%, 44%, 50%, 33%, 61%, 61%, and 75% by GP, A and E, in-patient referral, surgical foundation year-1, surgical senior house officer (SHO), surgical registrar, and surgical consultant respectively. The percentage of clinical consensus diagnosis was 12%. Surgery was performed in 48.8% of patients. Sixty-seven percent of GP-referred patients, 31% of A and E-referred, and 25% of the in-patient referrals underwent surgery. Surgical SHO made the most contributions to the primary diagnostic pathway.
  
  
  CONCLUSIONS
  Approximately 85% of acute surgical patients can be diagnosed accurately along the diagnostic pathway. Patients referred by a GP are more likely to require surgery as compared to other referral sources. Surgical consultant was more likely to make correct surgical diagnosis, however it is the surgical SHO that contributes the most correct diagnoses along the diagnostic pathway.
authors.affiliation: Muhammad Shafique Sajid, William FA Miles, Department of General, Laparoscopic and Endoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Muhammad Shafique
authors.initials: MS
authors.lastname: Sajid
authors.affiliation: Muhammad Shafique Sajid, William FA Miles, Department of General, Laparoscopic and Endoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Thaddeus
authors.initials: T
authors.lastname: Hollingsworth
authors.affiliation: Muhammad Shafique Sajid, William FA Miles, Department of General, Laparoscopic and Endoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: McGlue
authors.affiliation: Muhammad Shafique Sajid, William FA Miles, Department of General, Laparoscopic and Endoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex BN11 2DH, United Kingdom.
authors.forename: William Fa
authors.initials: WF
authors.lastname: Miles
keywords: Diagnostic accuracy; Diagnostic error; Misdiagnosis; Premature closure