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Yield of review of systems in a self-administered questionnaire
1Department of Family and Community Medicine, University of California at San Francisco, USA.
Background:
Family physicians frequently screen new patients with questionnaires that include a standard review of systems. The diagnostic yield of such questionnaires is unknown.
Methods:
We retrospectively compared results of 248 patient questionnaires with the clinicians' dictated medical record in a university-based family medicine practice. Any positive responses in the review of systems section were compared with the medical record to determine whether they resulted in a new diagnosis and a therapeutic maneuver.
Results:
The case-finding yield for the review of systems section as a whole was 10.5 percent. This yield compares favorably with other screening maneuvers in clinical practice. Individual questions had yields of 0.0 to 1.6 percent. The positive predictive value for a given yes response on the review of systems, defined as new diagnoses divided by total yes answers, was 3.3 percent.
Conclusions:
Compared with other case finding maneuvers in clinical practice, the review of systems questionnaire has a very acceptable yield. Its positive predictive value is low, however, and there are differences observed among physicians. Certain questions had a positive predictive value of 0.0 and could be deleted, which would produce a shortened review of systems section.