Ke. Mousa et al., The predictive value of provisional clinical diagnosis in the evaluation of respiratory disorders, ANN SAUDI M, 19(2), 1999, pp. 93-96
Background: Many non-pulmonary physicians in hospital and family care pract
ice base the diagnosis of pulmonary disorders on clinical impressions made
from the history and physical examination. Experience has shown that relyin
g on these parameters alone is not adequate, since this may result in missi
ng a significant number of diseases, or in the unnecessary treatment of oth
ers. This study set out to compare the sensitivity, specificity and positiv
e predictive value of the clinical assessment (provisional clinical diagnos
is or PCD) with the combined clinical assessment and other investigations,
including pulmonary function test (PFT).
Patients and Methods: One thousand and fifteen (1015) patients referred for
PFT to the pulmonary function laboratory of a teaching hospital were invol
ved in the study. The referring physicians were asked to fill a specially p
repared form giving details of the patients' history and clinical assessmen
t. The PFT was performed using an Erich-Jager Master Lab.
Results: Analysis of the final diagnosis revealed that only 51% of patients
with a pre-evaluation diagnosis of asthma were actually confirmed to have
asthma after further tests. Similar findings of 59% and 52% of patients wit
h chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis were
observed, respectively. The positive predictive value of PCD for asthma and
lung fibrosis was 64.1% and 61.9%, respectively, while that for CORD was 7
4.2%.
Conclusion: This study showed conclusively that the predictive value of pro
visional clinical diagnosis in the evaluation of pulmonary disorders is usu
ally inadequate, and needs to be augmented with additional simple investiga
tions such as PFT, in order to establish a more accurate diagnosis.