Download PDF
Methods Inf Med 1983; 22(01): 15-18
DOI: 10.1055/s-0038-1635420
Original Article
Schattauer GmbH

The Reliability of Medical History and Physical Examination in Patients with Acute Abdominal Pain

Die Zuverlässigkeit Der Krankengeschichte Und Ärztlichen Untersuchung Bei Patienten Mit Akuten Bauchschmerzen
B. Bjerregaard
1   From the Department of Surgical Gastroenterology, Hvidovre Hospital, and the Institute of Medical Genetics, University of Copenhagen
,
S. Brynitz
1   From the Department of Surgical Gastroenterology, Hvidovre Hospital, and the Institute of Medical Genetics, University of Copenhagen
,
J. Holst-Christensen
1   From the Department of Surgical Gastroenterology, Hvidovre Hospital, and the Institute of Medical Genetics, University of Copenhagen
,
P. Jess
1   From the Department of Surgical Gastroenterology, Hvidovre Hospital, and the Institute of Medical Genetics, University of Copenhagen
,
Eeva Kalaja
1   From the Department of Surgical Gastroenterology, Hvidovre Hospital, and the Institute of Medical Genetics, University of Copenhagen
,
J. Lund-Kristensen
1   From the Department of Surgical Gastroenterology, Hvidovre Hospital, and the Institute of Medical Genetics, University of Copenhagen
,
C. Thomsen
1   From the Department of Surgical Gastroenterology, Hvidovre Hospital, and the Institute of Medical Genetics, University of Copenhagen
› Author Affiliations
Further Information

Publication History

Publication Date:
19 February 2018 (online)

    Permissions and Reprints

The reliability of medical record information is of fundamental importance to the certainty with which a diagnosis can be made. 40 patients were chosen at random and each was examined by four clinicians. The information and a tentative diagnosis were written on a special record form. The results were judged by means of the coefficient kappa. The clinicians disagreed more on symptoms than on diagnoses. The diagnoses made by an automatic diagnosis system showed lower precision and lower accuracy than the clinicians’ diagnoses. The results of the study might explain why computer assistance in diagnostics is of limited value.

Die Zuverlässigkeit der Information aus dem Krankenblatt ist von grundlegender Bedeutung für die Sicherheit der Diagnose. 40 Patienten wurden zufällig ausgewählt. Jeder von ihnen wurde von vier Klinikern untersucht. Die Information und eine vorläufige Diagnose wurden auf einem besonderen Formular vermerkt. Die Ergebnisse wurden mit Hilfe des Koeffizienten Kappa beurteilt. Die Kliniker waren sich eher bezüglich der Symptome uneinig als bezüglich der Diagnosen. Die über ein automatisches Diagnosesystem erstellten Diagnosen waren ungenauer als die Diagnosen der Kliniker. Die Ergebnisse der Studie könnten erklären, warum die Computerunterstützung in der Diagnostik von begrenztem Wert ist.

Key-Words

Observer Variation - Medical History - Physical Examination - Computer-aided Diagnosis - Acute Abdominal Pain

Schlüssel-Wörter

Beobachtervariation - Krankengeschichte - ärztliche Untersuchung - computerunterstützte Diagnose - akute Bauchschmerzen
 

  • References

  • 1 Arends J., Uldall A.. The Reliability of Pregnancy Tests performed by Trained and Untrained Persons. Danish Med. Bull 1977; 24: 115-116.
    PubMedGoogle Scholar
  • 2 Bjerregaard B.. Computer-Hjadp i den Diagnostiske Bes-lutningsproces.. Licentiatprojekt. Arvebiologisk Institut. Københavns Universitet 1978
    PubMedGoogle Scholar
  • 3 Chamberlain G., Johnstone F. D.. Reliability of the History.. Lancet 1975; 01: 103.
    PubMedGoogle Scholar
  • 4 Cochrane A. L., Chapman P. J., Oldham P. D.. Observers’ Errors in Taking Medical Histories.. Lancet 1951; II 1007-1009.
    PubMedGoogle Scholar
  • 5 Cohen J.. A Coefficient of Agreement for Nominal Scales.. Educ. Psychol. Measurement 1960; 1: 37-46.
    PubMedGoogle Scholar
  • 6 Fairbairn A. S., Wood C. H., Fletcher C. M. Variability in Answers to a Questionnaire on Respiratory Symptoms. Brit. J. Brit. soc. Med 1959; 13: 175-193.
    PubMedGoogle Scholar
  • 7 Fleiss J. L., Cohen J.. The Equivalence of Weighted Kappa and the Intraclass Correlation Coefficient as Measures of Reliability.. Educ. Psychol. Measurement 1973; 33: 613-619.
    CrossrefPubMedGoogle Scholar
  • 8 Fleiss J. L.. Measuring Agreement between Two Judges on the Presence or Absence of a Trait.. Biometrics 1975; 31: 651-659.
    CrossrefPubMedGoogle Scholar
  • 9 Fletcher C. M.. The Problem of Observer Variation in Medical Diagnosis with Special Reference to Chest Diseases. Meth. Inform. Med 1964; 3: 98-103.
    PubMedGoogle Scholar
  • 10 Garland L. H.. Studies on the Accuracy of Diagnostic Procedures. Amer. J. Röntg 1959; 82: 25-38.
    PubMedGoogle Scholar
  • 11 Gill P. W., Leaper D. J., Guillou P. J., Staniland J. R., Horrocks J. C, de Dombal F. T.. Observer Variation in Clinical Diagnosis—A Computer-aided Assessment of its Magnitude and Importance in 552 Patients with Abdominal Pain. Meth. Inform. Med 1973; 12: 108-113.
    PubMedGoogle Scholar
  • 12 GJørup T., Bugge P. M.. Anamnestiske Oplysningers NøJ-agtighed. Ugeskr. Læg 1979; 140: 2846-2848.
    PubMedGoogle Scholar
  • 13 Good I. J., Card W. I.. The Diagnostic Process with Special Reference to Errors. Meth. Inform. Med 1971; 10: 176-188.
    PubMedGoogle Scholar
  • 14 Herman P. G., Gerson D. E., Hessel S. J., Mayer B. S., Watnick M., Blesser B., Ozonoff D.. Disagreements in Chest Röntgen Interpretation.. Chest 1975; 68: 278-282.
    CrossrefPubMedGoogle Scholar
  • 15 Komaroff A. L.. The Variability and Inaccuracy of Medical Data.. Proc. IEEE 1979; 67: 1196-1207.
    CrossrefPubMedGoogle Scholar
  • 16 Koran L. M.. The Reliability of Clinical Methods, Data and Judgments. New Engl. J. Med 1975; 293 642-646 695-701.
    CrossrefPubMedGoogle Scholar
  • 17 Lindberg G.. Effects of Observer Variation on Performance in Probabilistic Diagnosis of Jaundice. Meth. Inform. Med 1981; 20: 163-168.
    PubMedGoogle Scholar
  • 18 Theodossi A., Knill-Jones R. P., Skene A., Lindberg G., Bjerregaard B., Holst-Christensen J., Williams R.. Inter-Observer Variation of Symptoms and Signs in Jaundice.. Liver 1981; 1: 21-32.
    PubMedGoogle Scholar