Review of systems, physical examination, and routine tests for case-finding in ambulatory patients.
The screening value of the comprehensive review of systems and the complete physical examination in detecting unsuspected diseases for which therapeutic interventions are initiated has not been formally studied in ambulatory patients.
The medical records of 100 randomly selected adult patients who had an ambulatory general medical evaluation at the Mayo Clinic in 1990-1991 were surveyed to compare review of systems and physical examination with routine laboratory tests, chest radiography, and electrocardiography as case-finding maneuvers.
The main outcome measure was the therapeutic yield of each case-finding maneuver, defined as the proportion of maneuvers leading to a new therapy for a new clinically important diagnosis.
The utilization rate of routine tests in the 100 patients was high, ranging from 77 to 98%. Overall, the case-finding maneuvers led to 36 unsuspected clinically important diagnoses and resulted in 25 new therapeutic interventions.
Higher therapeutic yield was observed for review of systems (7%), physical examination (5%), and lipid screening (9.2%) than for chemistry group (2.2%), complete blood count (1.8%), thyroid tests (1.5%), urinalysis (1.1%), electrocardiography (0%), or chest radiography (0%). The number of therapeutic interventions was not associated with patient's age (P=0.55), sex (P=0.88), comorbidity (P=0.30) or with the time interval since the last general medical evaluation (P=0.12).
Based on therapeutic yield.
Mots-clés Pascal : Soin, Ambulatoire, Exploration clinique, Analyse routine, Examen laboratoire, Exploration radiologique, Diagnostic, Dépistage, Evaluation performance, Politique sanitaire, Etats Unis, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Care, Ambulatory, Clinical investigation, Routine analysis, Laboratory investigations, Radiologic investigation, Diagnosis, Medical screening, Performance evaluation, Health policy, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0357828
Code Inist : 002B30A01C. Création : 01/03/1996.