病史和体检及辅助检查对内科门诊患者疾病诊断价值的研究

目的定量评价物理诊断和辅助检查对内科门诊疾病诊断的价值。方法前瞻性观察2008年10月10日至16日就诊于北京协和医院普通内科门诊的145例患者，进行12个月的随访，分别计算病史、体检和辅助检查对最终诊断的贡献。结果19例（13．1％）患者失访。86例（68．3％，95％CI60．2％～76．4％）患者通过病史得到了正确诊断。通过体检或辅助检查得到正确诊断的病例数各为20例（15．9％，95％CI9．5％～22．3％）。医生通过询问病史获得的诊断信心指数平均为7．3，体检和辅助检查分别将其增加至7．9和8．7。结论大多数内科门诊疾病通过病史可以获得正确诊断。在物理诊断的基础上合理选择辅助检查是提高临床诊断水平的关键。

Contribution of history-taking, physical examination and laboratory investigation to diagnoses for medical outpatients

Objective To quantitatively evaluate relative contribution of medical history,physical examination and laboratory investigation to diagnoses for medical outpatients.Methods In total,145 medical visitors to the outpatient department of Peking Union Medical College Hospital (PUMCH) during October 10 to 16,2008 were recruited and followed-up for 12 months.Results Nineteen of 145 visitors (13.1%) were lost during the period of follow-up and diagnoses were established for 86 of them (68.3%)finally with medical history and for 20 (15.9%) with physical examination or laboratory investigation,respectively.Confidence index of internists in their correct diagnosis increased to 7.3 with medical history and to 7.9 and 8.7 with physical examination and laboratory investigation in average,respectively.Conclusions Most visitors to internal medicine department could be diagnosed correctly with medical history only.On the basis of physical diagnosis,selection of adequate laboratory investigation for them is critical to improvement of clinical diagnosis.