Muls A C, Klimova K, Andreyev H J N
The GI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
Eur J Cancer Care (Engl). 2018 Jan;27(1). doi: 10.1111/ecc.12766. Epub 2017 Sep 11.
In patients with gastrointestinal (GI) disorders, identical symptoms may occur for many different reasons. This prospective study assessed whether experienced clinicians can predict accurately the underlying diagnosis or diagnoses contributing to specific symptoms based on the history and physical examination. Three clinicians assessed 47 patients referred for management of troublesome GI symptoms identified after treatment for cancer. Investigations were requested following our comprehensive, peer-reviewed algorithm. The clinicians then recorded their predictions as to the results of those investigations. After each patient had completed all their investigations, had received optimal management and had been discharged from the clinic, the predicted diagnoses were compared to those made. The clinicians predicted 92 diagnoses (1.9 per patient). After investigation, a total of 168 unique diagnoses were identified (3.5 per patient). Of the 92 predicted diagnoses, 41 (43%) matched the diagnosis. Of the 168 actual diagnoses identified, only 24% matched the prediction. None of the clinicians predicted the correct combination of diagnoses contributing to bowel symptoms. Clinical acumen alone is inadequate at determining cause for symptoms in patients with GI symptoms developing after cancer therapy.
在患有胃肠道（GI）疾病的患者中，许多不同原因可能导致相同的症状。这项前瞻性研究评估了经验丰富的临床医生是否能够根据病史和体格检查准确预测导致特定症状的潜在诊断。三位临床医生对47例因癌症治疗后出现令人困扰的胃肠道症状而前来就诊的患者进行了评估。按照我们经过同行评审的综合算法进行了相关检查。然后，临床医生记录他们对这些检查结果的预测。在每位患者完成所有检查、接受了最佳治疗并从诊所出院后，将预测诊断与实际诊断进行比较。临床医生共预测了92个诊断（每位患者1.9个）。经过检查，共确定了168个不同的诊断（每位患者3.5个）。在92个预测诊断中，有41个（43%）与实际诊断相符。在确定的168个实际诊断中，只有24%与预测相符。没有一位临床医生预测出导致肠道症状的正确诊断组合。仅靠临床敏锐度不足以确定癌症治疗后出现胃肠道症状的患者的症状原因。
