Symptomatic diagnoses in primary care: an observational cohort study

It can be impossible to assign a definitive diagnosis for symptoms reported or observed by primary health care patients. In these situations, symptomatic diagnoses are often used.

The aim of the present study was to examine the proportion of symptomatic diagnoses among primary health care patients. We also explored which symptomatic diagnoses were most frequently recorded, as well as their distribution by age and sex.

This is a register-based study carried out in the public primary health care service of the city of Vantaa, Finland.

Diagnoses were entered according to the 10th revision of the International Classification of Diseases (ICD-10). The data consisted of every diagnosis entered into the electronic health record between 1 January 2016 and 31 December 2018. Both absolute numbers and relative proportions of various symptomatic diagnosis recordings (chapter 'R') were reported.

Of all the recorded diagnoses (n = 503 001), the proportion of R-diagnoses was 13.5% (n = 67 905). Diagnoses of symptoms and signs involving the digestive system and abdomen (R10-19) (3.7% of all; n = 18 550), the circulatory and respiratory systems (R00-09) (3.5%; n = 17 426), general symptoms and signs (R50-69) (3.0%; n = 15 165), and the skin and subcutaneous tissue (R20-23) (2.0%; n = 9812) were most prevalent. Age was also a major factor determining how symptomatic diagnoses were distributed between men and women. Overall, symptomatic diagnoses were more common among women than men (14.1% and 12.4%, respectively). The major categories of symptoms and signs involving the digestive system and abdomen, the skin and the subcutaneous tissue, and general symptoms and signs, were more predominant among women, while symptoms and signs involving the circulatory and respiratory systems were more common among men.

A symptomatic diagnosis code was recorded in about one eighth of GP appointments, although there were significant sex differences in the prevalence within and between diagnosis groups.