Although use of advanced diagnostic tools, such as CT scans and ultrasound, is becoming more common today, recent research from Israel1 shows that they may not be as powerful as simpler methods for diagnosing a variety of health problems. The study followed 442 individuals admitted from the hospital emergency department (ER) to a specific academic department of medicine during the 53 days of the study. Two doctors – a senior resident and a hospital physician – individually and separately examined patients on admission. The doctors had no influence on each other’s diagnoses, and both reviewed the same data. Each took the patient’s history, conducted a physical examination, and reviewed basic tests done in the ER, including blood and urine analysis, ECG, and chest radiography. Each also reviewed any extra tests done, such as CT scans and ultrasounds, and then made a diagnosis as in-depth as they could, while noting the tools that were most useful to them. Researchers then compared their results to the final diagnosis of each patient after discharge.

The study found that the senior resident was correct 80% of the time and the hospital physician was correct 84% of the time. The interesting revelation is that they both found the same tools to be the most helpful, and they might not be the ones you would expect. Both of them found that in about 40% of the patients they diagnosed, patient history and physical examination were the most useful tools, followed by a combination of history and basic tests, with or without a physical examination (33%), and then by history alone (20%). They also found that CT scans performed were only useful one out of every three times. This is important because tests such as CT scans, if used frequently, expose patients to levels of radiation that can lead to an increased risk of developing cancer over a lifetime.

This study suggests that it may be more useful for physicians to source traditional clinical information first, such as the patient’s history, to determine whether a scan is necessary.

First published in the Inside Tract® newsletter issue 180 – 2011
1. Paley L et al. Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital. Archive of Internal Medicine. 2011;171(15);1394-6.