The initial clinical probability in the diagnosis of the hospitalized pediatric patient

OBJECTIVES: 1. To determine the degree of correlation among different physicians concerning their initial diagnosis and 2. identify the degree of correlation between the probability that physicians assing an initial diagnosis and the number of days the patient is hospitalized, laboratory test and X-rays taken of the patient. DESIGN: A comparative questionnaire. STUDY SITE: Pediatric hospitalization Unit of a third level medical care ward of the Mexican Social Security Institute. STUDY UNITS: All new admissions or non-programmed readmitted patients to the hospital during the months of November and December 1990. MAIN MEASUREMENTS: The treating physicians (Staff pediatricians (MB) and third (R3) and second (R2) year residents) were each asked to independently assign a probability (0 to 100) to each of the diagnosis emitted on the day the patient was admitted. When the patient was discharged, the number of days hospitalized as well as the number of laboratory tests and X-rays taken of the patient were added. RESULTS: 106 patients were evaluated, a correlation was gathered between MBs and R3s of 0.79 (P less than 0.001) and among MBs and R2s of 0.83 (P less than 0.001). The correlation between resident physicians was discretely less 0.60 (P less than 0.01). When relating the probability assigned by the physicians and the number of days the patients were hospitalized, associations were observed of 0.31 (P less than 0.05), 0.15 (P less than 0.05) and 0.19 (P = 0.04) for the MB, R3 and R2s respectively. In the case of laboratory test a correlation of 0.38, 0.06 and 0.04 (MB, R3, R2 respectively) was found. None of these correlations were statistically significant. The X-rays showed a significant correlation in cases of the MBs (0.50, P less than 0.05). CONCLUSIONS: The probabilities assigned by the staff physician as well as the resident doctors are closely related and a lesser grade of association is seen when comparing the residents among each other. No tendencies were identified in the correlation of the probability assigned by the residents and the variables analyzed. A consistent relation was seen between the staff physician and high probabilities, longer stays, and greater number of laboratory tests and X-rays.