[Follow-up of unclear disease presentations in internal medicine]

A retrospective analysis of 11,147 case notes of admissions to the medical department of a general hospital in Bremen in 1983-1985 revealed that, despite intensive diagnostic measures, the diagnosis remained in doubt on discharge in 172 patients. In this group the most common disease pictures were feverish infection, syncope, chronic pain, unclear inflammatory disease and unclear haematological changes. The mean hospital stay of 23.2 days was significantly longer than the mean duration for all patients (15.4 d). Of 139 patients without acute infection 124 were followed-up for a period of 13.7 +/- 6.5 months after discharge. Among these 124 patients 71 (57.3%) felt well or improved, 5 (4%) had got worse, no change had occurred in 18 (14.4%) and 30 (24.2%) had died. A definitive diagnosis was made during the follow-up period in 23 (18.5%), but in only seven did this lead to treatment which brought about improvement.