title: High diagnostic value of general practitioners' presumptive diagnosis for pyelonephritis, meningitis and pancreatitis.
abstract: BACKGROUND
  In Denmark, patients referred from the general practitioner (GP) to the emergency department (ED) can be referred with either specific symptoms or with a presumptive diagnosis. The aim of the present study was to evaluate the diagnostic accuracy for various presumptive diagnoses made by the GP in a population acutely referred to an ED.
  
  
  METHODS
  This was a retrospective cohort study of all registered acute referrals for admission to Kolding ED in 2010. Eight presumptive diagnoses were selected for further studies: meningitis, acute coronary syndrome (ACS), pulmonary embolism, pneumonia, pancreatitis, deep venous thrombosis (DVT), pyelonephritis and intestinal obstruction. The presumptive diagnoses were compared with the final diagnosis on discharge. Sensitivity, specificity, predictive values and likelihood ratios were calculated.
  
  
  RESULTS
  A total of 8,841 patients were enrolled. The highest and lowest sensitivities were seen for DVT (90%) and meningitis (36%), respectively; and the highest and lowest values for specificity were observed for meningitis (99%) and ACS (30%), respectively. The positive predictive value had a wide range with the lowest value for ACS (9%) and the highest for pneumonia (59%). For pyelonephritis, meningitis and pancreatitis, the likelihood ratio of a positive test was above 10. The likelihood ratio of a negative test was above 0.1 for all diagnoses.
  
  
  CONCLUSIONS
  Patients referred with the presumptive diagnoses pyelonephritis, meningitis and pancreatitis had a high likelihood of having the disease in question. It is important not to discard any of the included presumptive diagnoses even if the GPs fail to suggest them on admission.
  
  
  BACKGROUND
  none.
  
  
  BACKGROUND
  none.
authors.affiliation: christian.backer.mogensen@rsyd.dk.
authors.forename: Srishamanthi
authors.initials: S
authors.lastname: Sriskandarajah
authors.forename: Rasmus
authors.initials: R
authors.lastname: Carter-Storch
authors.forename: Ulrik
authors.initials: U
authors.lastname: Frydkjær-Olsen
authors.forename: Christian Backer
authors.initials: CB
authors.lastname: Mogensen
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards; D003718:Denmark; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000379:methods / Q000706:statistics & numerical data; D058005:General Practitioners / Q000592:standards; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008581:Meningitis / Q000175:diagnosis*; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000175:diagnosis*; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity