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Question clinique
Is clinician gestalt as accurate as clinical decision rules in diagnosing acute respiratory illnesses?
L’Essentiel
In this limited systematic review, clinicians were at least as accurate as clinical decision rules in diagnosing and ruling out common acute respiratory illnesses. 1a
Référence
Plan de l'etude: Meta-analysis (other)
Financement: Self-funded or unfunded
Cadre: Outpatient (any)
Sommaire
These authors searched PubMed and Google (limited to the first 50 "hits") to identify prospective studies that compared the accuracy of overall clinical impression (aka gestalt) with clinical decision rules in the diagnosis of various respiratory infections: community-acquired pneumonia, acute rhinosinusitis, acute bacterial rhinosinusitis, and strep pharyngitis. They also manually searched the bibliographies of included studies, as well as published systematic reviews. The authors limited the studies to those taking place in ambulatory care settings: primary care offices, urgent care facilities, and emergency departments. Ultimately they included 16 studies with 6667 patients. Eleven studies included adults only, 4 studies included children only, and 1 study included both. Nine studies evaluated 5627 patients with suspected pneumonia, 3 studies evaluated 498 patients with suspected strep pharyngitis, and 4 studies evaluated 542 patients with suspected rhinosinusitis. Eight of the studies were at low risk of bias, 6 were of moderate risk, and 3 were of high risk. Overall, the clinicians performed well! For community-acquired pneumonia in adults, the clinicians were moderately good at ruling in and ruling out pneumonia (positive likelihood ratio [LR+] 7.7; 95% CI 4.8 - 11.5; negative likelihood ratio [LR-] 0.54; 0.42 - 0.65). However, their diagnoses were less reliable in children (LR+ 2.7; 1.1 - 4.3; LR- 0.63; 0.20 - 0.98). The clinicians were not all that good in diagnosing rhinosinusitis or bacterial sinusitis (LR+ 3 - 4; 2 - 6; LR- 0.3; 0.2 - 0.5) or strep pharyngitis (LR+ 2.1; 1.6 - 2.8; LR- 0.47; 0.36 - 0.60). The decision rules, by the way, performed worse or similar in every instance except in ruling out strep!
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Commentaires
Clinical "gestalt"
Using the term clinical "gestalt" creates unnecessary confusion and complication. It is not useful to co-opt this word from the field of psychology.
"Clinical impression" or "Clinical judgment" are quite clear in their meaning. No need to promote more medical babble.
Robert Langford (Toronto)
Unnecessary barriers on decision and planning of human thoughts
Dear Respected SIR/MAM-CMA-Canada,
It is one kind of confusion towards human thoughts in human brain. It cam make anxiety and depression to human mind. As, a result the patient gets sleepless whole night sometimes but , not always.The patient gets barriers to take any decision and planning towards his /her personal/professional/family/social life atmosphere. Due to brain injury , brain pain , brain infection, brain bleeding in side , missing of own wife /own husband/own children/own parents /own brothers and sisters /own good well wisher friends -it can happen . The patient must go to doctors /family doctors /clinical psychologist/psychologist/clinical counselors /nurse doctor scientist for prescribed medicine and counseling towards getting recovery of the patients. For many patients from one to three months treatment can settle this problems. Sometimes only COUNSELING by specialists can give soon recovery towards patients confusion. But , patients can pass good family and social life to take treatment by doctors. Best wishes to global patients and global doctors.
Good Heath to dear respected all.
Respectfully.
Dr.Muhammad Arif Rana
Global Family Doctor(LDM Roll-224)-WONCA at SIG Based in Manikganj-Bangladesh.
International Resident Member (IMG)-CMAID-680777-CMA-Canada.
Facebook: MUHAMMADARIFRANA.
Date : September. 20 -2019-Friday-08:00 PM.
(With warmest wishes )