A prospective evaluation of the medical consultation system CADIAG-II/RHEUMA in a rheumatological outpatient clinic

To evaluate the performance of CADIAG-II/RHEUMA as consultant in the primar y evaluation of patients visiting a rheumatological outpatient clinic, a CA DIAG-II/RHEUMA consultation was done for 54 patients and the list of genera ted diagnostic hypotheses was compared to each clinical discharge diagnosis . For 26 of a total of 126 rheumatological discharge diagnoses, no matching CADIAG-II/RHEUMA diagnosis was available. 94% of all other discharge diagn oses were found in the list of CADIAG-II/RHEUMA hypotheses, 82% among the f irst third of the list of hypotheses and 48% among the first five hypothese s. We identified the following factors limiting the ability of CADIAG-II/RH EUMA to generate a comprehensive and correctly ranked list of diagnostic hy potheses: (1) a large percentage of patients with early stages of not clear ly identified rheumatological conditions; (2) the limited number of CADIAG- II/RHEUMA diagnoses compared to the large number of known rheumatological c onditions; (3) the fact that rheumatological diseases are rarely characteri zed by a single pathognomonic feature but are usually diagnosed by combinat ions of rather unspecific findings.