Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome

Kurt Kroenke, A. David Mangelsdorff

Research output: Contribution to journalArticle

757 Citations (Scopus)

Abstract

purpose and patients and methods: Many symptoms in outpatient practice are poorly understood. To determine the incidence, diagnostic, findings, and outcome of 14 common symptoms, we reviewed the records of 1,000 patients followed by house staff in an internal medicine clinic over a three-year period. The following data were abstracted for each symptom: patient characteristics, symptom duration, evaluation, suspected etiology of the symptom, treatment prescribed, and outcome of the symptom. Cost estimates for diagnostic evaluation were calculated by means of the schedule of prevailing rates for Texas employed by the Civilian Health and Medical Program of the Uniformed Services for physician reimbursement. results: A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent. The cost of discovering an organic diagnosis was high, particularly for certain symptoms, such as headache ($7,778) and back pain ($7,263). Treatment was provided for only 55 percent of the symptoms and was often ineffective. Where outcome was documented, 164 (53 percent) of 307 symptoms improved. Three favorable prognostic factors were an organic etiology (p = 0.006), a symptom duration of less than four months (p = 0.009), and a history of two or fewer symptoms (p = 0.001). conclusion: The classification, evaluation, and management of common symptoms need to be refined. Diagnostic strategies emphasizing organic causes may be inadequate.

Original languageEnglish (US)
Pages (from-to)262-266
Number of pages5
JournalThe American Journal of Medicine
Volume86
Issue numberC
DOIs
StatePublished - 1989
Externally publishedYes

Fingerprint

Ambulatory Care
Incidence
Back Pain
Headache
Costs and Cost Analysis
Symptom Assessment
Hypesthesia
Sleep Initiation and Maintenance Disorders
Dizziness
Erectile Dysfunction
Constipation
Therapeutics
Internship and Residency
Internal Medicine
Chest Pain
Cough
Dyspnea
Abdominal Pain
Fatigue
Weight Loss

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Common symptoms in ambulatory care : Incidence, evaluation, therapy, and outcome. / Kroenke, Kurt; Mangelsdorff, A. David.

In: The American Journal of Medicine, Vol. 86, No. C, 1989, p. 262-266.

Research output: Contribution to journalArticle

@article{b587e9f1b3794832b694d457e17fcd2c,
title = "Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome",
abstract = "purpose and patients and methods: Many symptoms in outpatient practice are poorly understood. To determine the incidence, diagnostic, findings, and outcome of 14 common symptoms, we reviewed the records of 1,000 patients followed by house staff in an internal medicine clinic over a three-year period. The following data were abstracted for each symptom: patient characteristics, symptom duration, evaluation, suspected etiology of the symptom, treatment prescribed, and outcome of the symptom. Cost estimates for diagnostic evaluation were calculated by means of the schedule of prevailing rates for Texas employed by the Civilian Health and Medical Program of the Uniformed Services for physician reimbursement. results: A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent. The cost of discovering an organic diagnosis was high, particularly for certain symptoms, such as headache ($7,778) and back pain ($7,263). Treatment was provided for only 55 percent of the symptoms and was often ineffective. Where outcome was documented, 164 (53 percent) of 307 symptoms improved. Three favorable prognostic factors were an organic etiology (p = 0.006), a symptom duration of less than four months (p = 0.009), and a history of two or fewer symptoms (p = 0.001). conclusion: The classification, evaluation, and management of common symptoms need to be refined. Diagnostic strategies emphasizing organic causes may be inadequate.",
author = "Kurt Kroenke and Mangelsdorff, {A. David}",
year = "1989",
doi = "10.1016/0002-9343(89)90293-3",
language = "English (US)",
volume = "86",
pages = "262--266",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "C",

}

TY - JOUR

T1 - Common symptoms in ambulatory care

T2 - Incidence, evaluation, therapy, and outcome

AU - Kroenke, Kurt

AU - Mangelsdorff, A. David

PY - 1989

Y1 - 1989

N2 - purpose and patients and methods: Many symptoms in outpatient practice are poorly understood. To determine the incidence, diagnostic, findings, and outcome of 14 common symptoms, we reviewed the records of 1,000 patients followed by house staff in an internal medicine clinic over a three-year period. The following data were abstracted for each symptom: patient characteristics, symptom duration, evaluation, suspected etiology of the symptom, treatment prescribed, and outcome of the symptom. Cost estimates for diagnostic evaluation were calculated by means of the schedule of prevailing rates for Texas employed by the Civilian Health and Medical Program of the Uniformed Services for physician reimbursement. results: A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent. The cost of discovering an organic diagnosis was high, particularly for certain symptoms, such as headache ($7,778) and back pain ($7,263). Treatment was provided for only 55 percent of the symptoms and was often ineffective. Where outcome was documented, 164 (53 percent) of 307 symptoms improved. Three favorable prognostic factors were an organic etiology (p = 0.006), a symptom duration of less than four months (p = 0.009), and a history of two or fewer symptoms (p = 0.001). conclusion: The classification, evaluation, and management of common symptoms need to be refined. Diagnostic strategies emphasizing organic causes may be inadequate.

AB - purpose and patients and methods: Many symptoms in outpatient practice are poorly understood. To determine the incidence, diagnostic, findings, and outcome of 14 common symptoms, we reviewed the records of 1,000 patients followed by house staff in an internal medicine clinic over a three-year period. The following data were abstracted for each symptom: patient characteristics, symptom duration, evaluation, suspected etiology of the symptom, treatment prescribed, and outcome of the symptom. Cost estimates for diagnostic evaluation were calculated by means of the schedule of prevailing rates for Texas employed by the Civilian Health and Medical Program of the Uniformed Services for physician reimbursement. results: A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent. The cost of discovering an organic diagnosis was high, particularly for certain symptoms, such as headache ($7,778) and back pain ($7,263). Treatment was provided for only 55 percent of the symptoms and was often ineffective. Where outcome was documented, 164 (53 percent) of 307 symptoms improved. Three favorable prognostic factors were an organic etiology (p = 0.006), a symptom duration of less than four months (p = 0.009), and a history of two or fewer symptoms (p = 0.001). conclusion: The classification, evaluation, and management of common symptoms need to be refined. Diagnostic strategies emphasizing organic causes may be inadequate.

UR - http://www.scopus.com/inward/record.url?scp=0024574193&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024574193&partnerID=8YFLogxK

U2 - 10.1016/0002-9343(89)90293-3

DO - 10.1016/0002-9343(89)90293-3

M3 - Article

C2 - 2919607

AN - SCOPUS:0024574193

VL - 86

SP - 262

EP - 266

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - C

ER -