Burack R C, Carpenter R R
J Fam Pract. 1983 Apr;16(4):749-54.
The relationship between the presenting complaint and the principal problem identified during 103 new patient visits was assessed in an academic primary care setting. Complaints and problems were classified by content as somatic, psychosocial, or health maintenance and compared by category. The presenting complaint correctly identified the category in 76 percent of somatic but only 6 percent of psychosocial principal problems (sensitivity of 76 percent and 6 percent, respectively). The likelihood of a same-category principal problem (positive predictive value) ranged from 53 percent for somatic to 100 percent for psychosocial presenting complaints. A specific underlying motivation for the visit other than the presenting complaint was noted by the primary provider in 42 percent of the encounters and was most frequent in those encounters characterized by a lack of concordance between complaint and problem. The presenting complaint introduces the clinical encounter, but its value is limited in specifically identifying the principal problem.
在一个学术性初级保健机构中，对103例新患者就诊时的主诉与所确定的主要问题之间的关系进行了评估。根据内容将主诉和问题分类为躯体性、心理社会性或健康维护性，并按类别进行比较。主诉在76%的躯体性主要问题中正确识别了类别，但在心理社会性主要问题中仅为6%（敏感性分别为76%和6%）。同一类别主要问题的可能性（阳性预测值）从躯体性主诉的53%到心理社会性主诉的100%不等。在42%的就诊中，初级医疗服务提供者指出了除主诉之外此次就诊的特定潜在动机，并且在那些主诉与问题不一致的就诊中最为常见。主诉开启了临床诊疗过程，但其在明确识别主要问题方面的价值有限。
