Abstract：
OBJECTIVE: Patients referred to general internal medicine (GIM) outpatient clinics may face a higher risk of diagnostic errors than non-referred patients. This difference in risk is assumed to be due to the differences in diseases and clinical presentations between referred and non-referred patients; however, clinical data regarding this issue are scarce. This study aimed to determine the frequency of diagnostic errors and compare the characteristics of referred and non-referred patients visit GIM outpatient clinics.
METHODS: This study included consecutive outpatients who visited the GIM outpatient clinic at a university hospital, with or without referral. Data on age, sex, chief complaints, referral origin, and final diagnosis were collected from medical records. The Revised Safer Dx Instrument was used to detect diagnostic errors.
RESULTS: Data from 534 referred and 599 non-referred patients were analyzed. The diagnostic error rate was higher in the referral group than that in the non-referral group (2.2 % vs. 0.5 %, p=0.01). The prevalence of abnormal test results and sensory disturbances was higher in the chief complaints, and the prevalence of musculoskeletal system disorders, connective tissue diseases, and neoplasms was higher in the final diagnoses of referred patients compared with non-referred patients. Among referred patients with diagnostic errors, abnormal test results and sensory disturbances were the two most common chief complaints, whereas neoplasia was the most common final diagnosis. Problems with data integration and interpretation were found to be the most common factors contributing to diagnostic errors.
CONCLUSIONS: Paying more attention to patients with abnormal test results and sensory disturbances and considering a higher pre-test probability for neoplasms may prevent diagnostic errors in patients referred to GIM outpatient clinics.
METHODS: This study included consecutive outpatients who visited the GIM outpatient clinic at a university hospital, with or without referral. Data on age, sex, chief complaints, referral origin, and final diagnosis were collected from medical records. The Revised Safer Dx Instrument was used to detect diagnostic errors.
RESULTS: Data from 534 referred and 599 non-referred patients were analyzed. The diagnostic error rate was higher in the referral group than that in the non-referral group (2.2 % vs. 0.5 %, p=0.01). The prevalence of abnormal test results and sensory disturbances was higher in the chief complaints, and the prevalence of musculoskeletal system disorders, connective tissue diseases, and neoplasms was higher in the final diagnoses of referred patients compared with non-referred patients. Among referred patients with diagnostic errors, abnormal test results and sensory disturbances were the two most common chief complaints, whereas neoplasia was the most common final diagnosis. Problems with data integration and interpretation were found to be the most common factors contributing to diagnostic errors.
CONCLUSIONS: Paying more attention to patients with abnormal test results and sensory disturbances and considering a higher pre-test probability for neoplasms may prevent diagnostic errors in patients referred to GIM outpatient clinics.
摘要：
目的：转诊到普通内科（GIM）门诊的患者比未转诊的患者可能面临更高的诊断错误风险。这种风险差异被认为是由于转诊和非转诊患者之间疾病和临床表现的差异；然而，关于这个问题的临床数据很少.本研究旨在确定诊断错误的频率，并比较转诊和非转诊患者就诊GIM门诊的特征。
方法：这项研究包括连续门诊患者，他们在大学医院的GIM门诊就诊，有或没有推荐。年龄数据,性别,首席投诉，转介起源，并从医疗记录中收集最终诊断。使用修订的更安全Dx仪器检测诊断错误。
结果：分析了534名转诊患者和599名非转诊患者的数据。转诊组的诊断错误率高于非转诊组(2.2%vs.0.5%,p=0.01)。主诉中检测结果异常和感觉障碍的患病率较高,以及肌肉骨骼系统疾病的患病率，结缔组织疾病,与未转诊患者相比，转诊患者的最终诊断中肿瘤更高。在有诊断错误的转诊患者中，异常的测试结果和感觉障碍是两个最常见的主要投诉，而肿瘤形成是最常见的最终诊断。发现数据集成和解释问题是导致诊断错误的最常见因素。
结论：对检测结果异常和感觉障碍的患者给予更多关注，并考虑对肿瘤进行更高的预检测概率，可以防止转诊到GIM门诊的患者的诊断错误。
方法：这项研究包括连续门诊患者，他们在大学医院的GIM门诊就诊，有或没有推荐。年龄数据,性别,首席投诉，转介起源，并从医疗记录中收集最终诊断。使用修订的更安全Dx仪器检测诊断错误。
结果：分析了534名转诊患者和599名非转诊患者的数据。转诊组的诊断错误率高于非转诊组(2.2%vs.0.5%,p=0.01)。主诉中检测结果异常和感觉障碍的患病率较高,以及肌肉骨骼系统疾病的患病率，结缔组织疾病,与未转诊患者相比，转诊患者的最终诊断中肿瘤更高。在有诊断错误的转诊患者中，异常的测试结果和感觉障碍是两个最常见的主要投诉，而肿瘤形成是最常见的最终诊断。发现数据集成和解释问题是导致诊断错误的最常见因素。
结论：对检测结果异常和感觉障碍的患者给予更多关注，并考虑对肿瘤进行更高的预检测概率，可以防止转诊到GIM门诊的患者的诊断错误。
