Utility of clinical examination in the diagnosis of emergency department patients admitted to the department of medicine of an academic hospital.

摘要

The claim that high-quality history and physical examination are diagnostic for most patients is hased on old studies and ambulatory patients. We examined in a prospective study the utility of basic clinical information available on admission for the diagnosis of adult patients admitted to the department of medicine. See also page 1396 Methods. All consecutive patients newly admitted from the emergency department (ED) to 1 academic department of medicine over 53 days were prospectively included in the study. Planned admissions or readmis-sions were excluded. A senior resident (SR) with 4 years' training (L.P.) examined all patients within 24 hours of admission, including a full history taking, physical examination, and review of ancillary test findings done at the ED (basic hematology and chemistry tests, urinaly-sis, electrocardiography [ECG], and chest radiography [CXR]). Additional tests (troponin, C-reactive protein, and international normalized ratio) and computed tomography or ultrasonography (when preformed), medical charts from previous admissions, and all medications and vital signs were also reviewed.