title: Prevalence of Inconsistencies in the Recorded Outcomes of Clinical Evaluations.
abstract: OBJECTIVE
  The aims of the study were to determine the prevalence of variations in the recorded outcomes of clinical evaluations by 2 different physicians during a single patient visit and to comment on observations of physician practices regarding history taking and physical examination.
  
  
  METHODS
  Structured interviews were conducted with both junior and supervising physicians after they had evaluated patients in a pediatric emergency department who presented with complaints of fever (temperature, >100.4°F) in infants younger than 3 months, fever (temperature, >102.2°F) in infants aged 3 to 12 months, headache in patients older than 5 years, abdominal pain in patients older than 5 years, and head injury in patients younger than 18 years. Data were analyzed with descriptive statistics.
  
  
  RESULTS
  Most of the data reported by both junior and supervising physicians showed response disagreement. The questions on fever (temperature, >102.2°F) in infants aged 3 to 12 months showed 29% (10/34) disagreement on fever duration and 45% (5/11) on fever height. Questions on abdominal pain in children older than 5 years showed 24% (24/100) disagreement on reporting right lower quadrant pain and 10% (11/106) on right lower quadrant tenderness on examination; however, the discrepancy rates were 56% (56/100) when considering less than complete agreement on all painful sites and 53% (56/106) on all tender sites. Supervising physicians questioned and examined patients presenting with abdominal pain more often than those presenting with other complaints.
  
  
  CONCLUSIONS
  There are significant variations in the recorded outcome of clinical evaluations by 2 different physicians during a single patient visit. Supervising physicians are more cautious to question and examine patients presenting with abdominal pain compared with other chief complaints.
authors.affiliation: From the *Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Baystate Medical Center, Tufts University School of Medicine; and †Division of Academic Affairs, Epidemiology and Biostatistician, Tufts University School of Medicine, Springfield, MA.
authors.forename: Zola
authors.initials: Z
authors.lastname: Trotter
authors.forename: Blake
authors.initials: B
authors.lastname: Spirko
authors.forename: Howard
authors.initials: H
authors.lastname: Smithline
authors.forename: Jane
authors.initials: J
authors.lastname: Garb
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000453:epidemiology*; D006261:Headache / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D014218:Triage / Q000379:methods*