Cited by 947Primary Care and Health OutcomesClinical Reasoning and Diagnostic SkillsChronic Disease Management Strategies

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

Kroenke, Kurt, Mangelsdorff, A.David·1989·The American Journal of Medicine

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

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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.

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Authors: Kroenke, K., & Mangelsdorff, A. D.
Affiliations: Uniformed Services University of the Health Sciences (US)
Brooke Army Medical Center (US)
ORCID: Kroenke, Kurt
Venue: The American Journal of Medicine
Publisher: Elsevier BV
Published: 1989-03
Volume: 86
Issue: 3
Pages: 262-266
ISSN: 0002-9343 (ISSN-L)
DOI: 10.1016/0002-9343(89)90293-3
OpenAlex: W1984623074
Cited by: 947
References: 39
Citations by year: 2026: 9 · 2025: 17 · 2024: 12 · 2023: 13 · 2022: 14 · 2021: 11 · 2020: 18 · 2019: 20 · 2018: 20 · 2017: 25 · 2016: 23 · 2015: 25 · 2014: 39 · 2013: 31 · 2012: 32
FWCI: 36.80
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The American Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords: common symptoms, outpatient care, symptom incidence, diagnostic assessment, treatment outcomes, organic etiology, diagnostic costs, symptom duration, prognostic factors, headache, back pain, chest pain, fatigue, dizziness, dyspnea, abdominal pain, cough, constipation, weight loss, insomnia, internal medicine clinic
MeSH terms: Ambulatory Care, Diagnosis, Disease, Female, Humans, Male, Military Personnel, Morbidity, Prognosis, Retrospective Studies

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

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