Acil Servis Hastalarının Tanısında Öykü, Fizik Muayene, Laboratuvar ve Görüntüleme Yöntemlerinin Etkinliklerinin Araştırılması

Abstract

The increase in the use of laboratory and imaging methods in parallel with technological developments has led to the decrease in the use of history and physical examination (PE), which are of the oldest diagnostic methods. In this study, we aimed to determine the rate of correct diagnosis with the history and PE to urgent and semi-urgent emergency patients. A total of 609 patients, admitted to the Emergency Service between January 4, 2020 and January 15, 2022 were included in the study. Of the patients, 54.8% were female, 6.5% were trauma-related, 72.7% were urgent, and 27.3% were semi-urgent. The rate of patients with the same initial diagnosis based on history and PE and discharge diagnosis was 51.9% in junior research assistants, 54.8% senior research assistants, and 61.4% in specialist doctors. The rate of accurate initial diagnosis by each of these groups of doctors did not change according to the age of the patients and the status as to whether a consultation was required or not. The rate of accurate diagnosis was higher among males according the evaluation of the senior research assistants, while it was higher in the presence of chronicle disease according the evaluation of senior and junior research assistants. Accurate diagnosis rates were higher in trauma patients yet the difference was not statistically significant, except for the patients evaluated by the senior research assistants. The use of laboratory examination alone led to 5.9% increase in the accurate diagnosis made by the specialists, while this ratio was 16.9% when imaging methods were used alone, and 30.7% when both laboratory examination and imaging methods were used. Emergency specialist diagnosis was the same as discharge diagnosis at a rate of 92.1%. Consequently, this study confirmed that the doctors with the 3 aforementioned levels of experience could accurately diagnose at least half of the urgent and semi-urgent patients admitted to the emergency care service with history and PE. In order to reduce the number of tests and the risks associated with the tests, physicians should be provided with the skills of taking good history, performing accurate and effective PE, and encouraged to use these skills.