Soler Jean K, Okkes Inge, Oskam Sibo, Van Boven Kees, Zivotic Predrag, Jevtic Milan, Dobbs Frank, Lamberts Henk
Faculty of Life and Health Sciences, University of Ulster, Coleraine, UK.
Inform Prim Care. 2012;20(1):25-39. doi: 10.14236/jhi.v20i1.45.
This is a study of the relationships between common reasons for encounter (RfEs) and common diagnoses (episode titles) within episodes of care (EoCs) in family practice populations in four countries.
Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the International Classification of Primary Care (ICPC), including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using Bayesian methods.
The RfE 'cough' is a strong, reliable predictor for the diagnoses 'cough' (a symptom diagnosis), 'acute bronchitis', 'URTI' and 'acute laryngitis/tracheitis' and a less strong, but reliable predictor for 'sinusitis', 'pneumonia', 'influenza', 'asthma', 'other viral diseases (NOS)', 'whooping cough', 'chronic bronchitis', 'wheezing' and 'phlegm'. The absence of cough is a weak but reliable predictor to exclude a diagnosis of 'cough', 'acute bronchitis' and 'tracheitis'. Its presence allows strong and reliable exclusion of the diagnoses 'gastroenteritis', 'no disease' and 'health promotion/prevention', and less strong exclusion of 'adverse effects of medication'. The RfE 'sadness' is a strong, reliable predictor for the diagnoses 'feeling sad/depressed' and 'depressive disorder'. It is a less strong, but reliable predictor of a diagnosis of 'acute stress reaction'. The absence of sadness (as a symptom) is a weak but reliable predictor to exclude the symptom diagnosis 'feeling sad/depressed'. Its presence does not support the exclusion of any diagnosis.
We describe clinically and statistically significant diagnostic associations observed between the RfEs 'cough' and 'sadness', presenting as a new problem in family practice, and all the episode titles in ICPC.
本研究旨在探讨四个国家家庭医疗人群中，就诊常见原因（RfEs）与医疗事件（EoCs）中的常见诊断（疾病名称）之间的关系。
参与研究的家庭医生（FDs）使用国际初级保健分类法（ICPC），以EoC结构记录其所有患者接触的详细信息，包括患者提出的RfEs以及FDs的诊断标签。使用贝叶斯方法研究RfEs与疾病名称之间的关系。
RfE“咳嗽”是诊断“咳嗽”（症状诊断）、“急性支气管炎”、“上呼吸道感染”和“急性喉炎/气管炎”的强有力且可靠的预测指标，对于“鼻窦炎”、“肺炎”、“流感”、“哮喘”、“其他病毒疾病（未特指）”、“百日咳”、“慢性支气管炎”、“喘息”和“咳痰”是较弱但可靠的预测指标。无咳嗽是排除“咳嗽”、“急性支气管炎”和“气管炎”诊断的弱但可靠的预测指标。咳嗽的存在可强有力且可靠地排除“肠胃炎”、“无疾病”和“健康促进/预防”的诊断，对“药物不良反应”的排除力度较弱。RfE“悲伤”是诊断“感到悲伤/抑郁”和“抑郁症”的强有力且可靠的预测指标。它是“急性应激反应”诊断的较弱但可靠的预测指标。无悲伤（作为症状）是排除症状诊断“感到悲伤/抑郁”的弱但可靠的预测指标。其存在不支持排除任何诊断。
我们描述了在RfEs“咳嗽”和“悲伤”与ICPC中的所有疾病名称之间观察到的具有临床和统计学意义的诊断关联，这在家庭医疗中是一个新问题。
