Guo Hui, Li Xu-Rui, Du Yun-Lei, Jia Yang-Juan, Li Hong-Ling, Zhao Qian, Li Yan-Peng, Li Jian-Guo
Department of Emergency, Hebei General Hospital, No.348 West Heping Boulevard, Shijiazhuang, Hebei Province, 050051, China.
Hereditas. 2025 Jul 18;162(1):134. doi: 10.1186/s41065-025-00507-3.
Diagnostic checklists have been demonstrated to reduce errors in clinical reasoning. Building on previous validation studies, this research presents the development and clinical application of an etiology-based diagnostic framework for evaluating acute abdominal pain. The framework integrates a structured checklist of abdominal pain etiologies with a process-oriented diagnostic strategy, aiming to enhance diagnostic accuracy and clinical outcomes. This approach also serves as a potential model for the creation of diagnostic tools applicable to other symptom complexes encountered in emergency medicine.
A cognitive task analysis (CTA) was conducted with participation from five emergency medicine experts employing a think-aloud methodology. The experts described their diagnostic reasoning processes and queried relevant clinical data to extract foundational diagnostic principles. Based on these findings, a checklist categorizing etiologies of abdominal pain was constructed, drawing from anatomical and diagnostic considerations. The clinical utility of the checklist was evaluated through its application to a representative complex case.
The diagnostic checklist was organized into five principal etiological categories: local organ disorders, diseases of adjacent organs, systemic diseases, psychogenic disorders, and gynecological conditions. Its implementation facilitated the accurate identification of atypical acute renal infarction in a diagnostically challenging case, enabling prompt clinical intervention.
CTA provides a robust method for modeling expert diagnostic reasoning and supports the development of structured, etiology-based diagnostic tools. This framework enhances diagnostic precision for individuals presenting with acute abdominal pain in emergency settings and may inform the development of similar tools for other clinical presentations.
诊断清单已被证明可减少临床推理中的错误。基于先前的验证研究，本研究介绍了一种基于病因的诊断框架的开发和临床应用，用于评估急性腹痛。该框架将腹痛病因的结构化清单与面向过程的诊断策略相结合，旨在提高诊断准确性和临床结果。这种方法还可作为创建适用于急诊医学中遇到的其他症状复合体的诊断工具的潜在模型。
采用出声思维法，邀请五位急诊医学专家参与进行了一项认知任务分析（CTA）。专家们描述了他们的诊断推理过程，并查询了相关临床数据以提取基本诊断原则。基于这些发现，从解剖学和诊断学考虑因素出发，构建了一份腹痛病因分类清单。通过将该清单应用于一个具有代表性的复杂病例来评估其临床实用性。
诊断清单分为五个主要病因类别：局部器官疾病、相邻器官疾病、全身性疾病、精神性疾病和妇科疾病。在一个诊断具有挑战性的病例中，其应用有助于准确识别非典型急性肾梗死，从而能够及时进行临床干预。
CTA为模拟专家诊断推理提供了一种强大的方法，并支持开发结构化的、基于病因的诊断工具。该框架提高了急诊环境中出现急性腹痛患者的诊断准确性，并可能为其他临床表现的类似工具的开发提供参考。
