Emergency Department, University Hospital Basel, Switzerland.
Swiss Med Wkly. 2019 Oct 27;149:w20141. doi: 10.4414/smw.2019.20141. eCollection 2019 Oct 7.
As a result of the ever-increasing use of imaging and clinical chemistry, symptom-oriented research has lost ground in many areas of clinical medicine. In emergency medicine, the importance of symptom-oriented research is obvious, as the three major tasks (triage, work-up and disposition) are still under-investigated. Scientific progress is closely linked to the analysis of readily available information, such as the patients’ symptoms. A decade ago, there were more questions than answers. Therefore, we describe the state of the evidence and the importance of symptoms for decisions at triage, during work-up and for disposition. Recent advances in each field focusing on symptoms as predictors of outcome and/or diagnosis are shown. Finally, future directions of research regarding novel triage tools, efficient work-up and evidence-based disposition are discussed. Symptom-oriented research has been a driver for medical progress for centuries, and re-focusing on patient-centred clinical research will strengthen this field in the future in order to support smarter medicine.
由于影像学和临床化学的应用日益增多，以症状为导向的研究在临床医学的许多领域已经失势。在急诊医学中，以症状为导向的研究至关重要，因为分诊、检查和处置这三大任务仍未得到充分研究。科学的进步与对现有信息（如患者的症状）的分析密切相关。十年前，提出的问题多于答案。因此，我们描述了分诊、检查和处置决策中症状的证据状态和重要性。展示了每个领域中以症状作为预后和/或诊断预测因子的最新进展。最后，讨论了关于新型分诊工具、高效检查和基于证据的处置的未来研究方向。以症状为导向的研究已经成为几个世纪以来医学进步的动力，未来重新关注以患者为中心的临床研究将加强这一领域，以支持更智能的医学。
