Physical examination in the care of medical inpatients: an observational study
Physical examination in the care of medical inpatients: an observational study
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DOI：
10.1016/s0140-6736(03)14464-9
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发表时间：
2003-10-04
期刊：
影响因子：
168.9
通讯作者：
Reilly, BM
中科院分区：
文献类型：
--
作者：
Reilly, BM
背景 人们对医院患者护理中熟练体检的临床重要性知之甚少。方法对普通内科住院服务收治的患者的系统连续样本的医院记录进行回顾性审查，以确定主治医生的体检结果是否会导致临床管理的重要变化。结果评审小组将具有关键体检结果的患者定义为因主治医师体检而导致医院诊断和治疗发生重大变化的患者。如果由此产生的治疗改变涉及咨询专家的积极合作，则关键发现被归类为已验证。如果后续的诊断测试（除了体检）可能会导致正确的诊断，则结果被归类为可发现的。 1 级发现是那些被认为已验证但不可发现的发现。发现 在 100 名患者中，26 名患者有关键的身体发现（26%；95% Cl 18-36）。其中 15 个（58%；95% Cl 37-77）经过验证（13 个通过紧急手术或其他侵入性操作），14 个是可发现的（54%；95% Cl 33-73）。 7 名患者有 1 类检查结果（7%；95% Cl 3-14）。 解释 体检对住院患者的护理有重大影响。如果在其他环境中复制，这些发现可能会对医学教育工作者和质量改进计划产生重要影响。
Background Little is known about the clinical importance of skilled physical examination in the care of patients in hospital.Methods Hospital records of a systematic consecutive sample of patients admitted to a general medical inpatient service were reviewed retrospectively to determine whether physical findings by the attending physician led to important changes in clinical management. Patients with pivotal physical findings were defined by an outcomes adjudication panel as those whose diagnosis and treatment in hospital changed substantially as a result of the attending physician's physical examination. Pivotal findings were classed as validated if the resulting treatment change involved the active collaboration of a consulting specialist. Findings were classed as discoverable if subsequent diagnostic testing (other than physical examination) would probably have led to the correct diagnosis. Class 1 findings were those deemed validated but not discoverable.Findings Among 100 patients, 26 had pivotal physical findings (26%; 95% Cl 18-36). 15 of these (58%; 95% Cl 37-77) were validated (13 with urgent surgical or other invasive procedures) and 14 were discoverable (54%; 95% Cl 33-73). Seven patients had class 1 findings (7%; 95% Cl 3-14).Interpretation Physical examination can have a substantial effect on the care of medical inpatients. If replicated in other settings, these findings might have important implications for medical educators and quality improvement initiatives.