Related Experiment Videos
Diagnosis deferred--the clinical spectrum of diagnostic uncertainty
I Lossos1, A Israeli, G Zajicek
1Department of Medicine B, Hadassah University Hospital, Jerusalem, Israel.
Abstract:
This study attempts to define the term "Diagnosis Deferred" (DD) and determine its natural history and outcome. It is suggested that such a "non-diagnosis" should be used when the clinical and laboratory picture cannot be explained by any known disease entity after a minimum of 5 days hospitalization. During a 9 year period (1972-1980) 250 patients (1.8%) were identified as warranting the term DD from a total of 14,098 admissions to a department of Internal Medicine. Their average stay in hospital was 11.5 days. There was no sex difference between the patients, whose average age was 42.8 +/- 17.6 years (mean +/- SD; range 14-93). Three complaints predominated: joint pains (21.6%), abdominal pain (20.4%) and chest pain (16.8%). In 103 of the patients, there was follow-up information until the diagnosis was made or for at least 24 months (average 53.0 +/- 40.0 months, range 2-186). These patients were representative of the original cohort in both age, sex and classification of symptoms. Forty-three patients (42%) were subsequently diagnosed. 58% of these patients were diagnosed as a result of a change in or appearance of a clinical symptom during the follow-up period. "The survival of diagnostic uncertainty" in 50% of the patients was 84.5 months (7 years) with a range of 2-13 years. This time was significantly shorter for chest pain than for abdominal pain (33 months vs 87 months) (p = 0.003). In patients with "Diagnosis Deferred", a diagnosis was reached in 42%; in 22% the symptoms disappeared leaving 36% undiagnosed, and a continuing clinical challenge.
Insights
Diagnosis Deferred (DD) is a temporary medical status for unexplained conditions. A significant portion of patients with DD eventually receive a diagnosis, often after symptom changes, while others remain undiagnosed.
Area of Science:
- Internal Medicine
- Clinical Diagnostics
- Medical Outcomes
Background:
- The term "Diagnosis Deferred" (DD) lacks a clear definition and established natural history.
- Unexplained clinical and laboratory findings necessitate a standardized approach for patient management.
Purpose of the Study:
- To define "Diagnosis Deferred" (DD) as a clinical status.
- To investigate the natural history and diagnostic outcomes for patients with DD.
Main Methods:
- Retrospective analysis of 14,098 Internal Medicine admissions over 9 years (1972-1980).
- Identification and characterization of 250 patients (1.8%) with "Diagnosis Deferred" status.
- Follow-up data collection for 103 patients for at least 24 months to ascertain diagnostic outcomes.
Main Results:
- The average age of patients with DD was 42.8 years, with predominant symptoms including joint, abdominal, and chest pain.
- A diagnosis was reached in 42% of patients during follow-up, with symptom evolution being a key factor in 58% of these cases.
- The median "survival of diagnostic uncertainty" was 84.5 months, significantly shorter for chest pain presentations.
Conclusions:
- "Diagnosis Deferred" can be operationally defined for patients with unexplained conditions after sufficient observation.
- A substantial proportion of patients initially classified as DD eventually receive a diagnosis, highlighting the dynamic nature of medical conditions.
- A significant percentage of patients remain undiagnosed, underscoring the need for continued research and improved diagnostic strategies.