Looking for "indicants" in the differential diagnosis of jaundice.

The differential diagnosis between intra- and extrahepatic causes of jaundice was studied. At the "20 Noviembre" ISSSTE Hospital in Mexico City, between January 1977 and May 1984, data were collected in 1,263 jaundiced patients. To the clinical data for 1,000 of these 1,263 patients and a new set of 105 jaundiced patients, the COMIC study group algorithm was applied. The differential diagnosis between medical and surgical causes of jaundice was correct in 90% of the cases. In 85% the algorithm could also differentiate between acute and chronic disease, or between benign and malignant causes of jaundice. The COMIC algorithm was then modified and applied to the same 1,000 cases examined previously, with 96% accuracy in distinguishing medical and surgical causes of jaundice and 94% accuracy in discriminating between acute and chronic, or benign and malignant, disease. In a new set of 105 cases of jaundiced patients the modified COMIC algorithm made the correct diagnosis between intra- and extrahepatic causes for 98% of the patients, and for 93% it was also capable of distinguishing benign from malignant and acute from chronic causes of jaundice.