Diagnosis deferred-the clinical spectrum of diagnostic uncertainty

I. Lossos, A. Israeli, G. Zajicek, E. M. Berry

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

This study attempts to define the term "Diagnosis Deferred" (DD) and determine its natural history and outcome. It is suggested that such a "non-diagnosis" should be used when the clinical and laboratory picture cannot be explained by any known disease entity after a minimum of 5 days hospitalization. During a 9 year period (1972-1980) 250 patients (1.8%) were identified as warranting the term DD from a total of 14,098 admissions to a department of Internal Medicine. Their average stay in hospital was 11.5 days. There was no sex difference between the patients, whose average age was 42.8 ± 17.6 years (mean ± SD; range 14-93). Three complaints predominated: joint pains (21.6%), abdominal pain (20.4%) and chest pain (16.8%). In 103 of the patients, there was follow-up information until the diagnosis was made or for at least 24 months (average 53.0 ± 40.0 months, range 2-186). These patients were representative of the original cohort in both age, sex and classification of symptoms. Forty-three patients (42%) were subsequently diagnosed. 58% of these patients were diagnosed as a result of a change in or appearance of a clinical symptom during the follow-up period. "The survival of diagnostic uncertainty" in 50% of the patients was 84.5 months (7 years) with a range of 2-13 years. This time was significantly shorter for chest pain than for abdominal pain (33 months vs 87 months) (p = 0.003). In patients with "Diagnosis Deferred", a diagnosis was reached in 42%; in 22% the symptoms disappeared leaving 36% undiagnosed, and a continuing clinical challenge.

Original languageEnglish (US)
Pages (from-to)649-657
Number of pages9
JournalJournal of Clinical Epidemiology
Volume42
Issue number7
DOIs
StatePublished - 1989
Externally publishedYes

Keywords

  • Abdominal pain
  • Chest pain
  • Diagnosis deferred
  • Joint pain

ASJC Scopus subject areas

  • Medicine(all)
  • Epidemiology
  • Public Health, Environmental and Occupational Health

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