4496:). Let's say that the histopathologic examination confirms primary hyperparathyroidism, but also showed a malignant pattern. By an initial method by epidemiology, the incidence of parathyroid carcinoma is estimated at 1 in 6 million people per year, giving a very low probability before taking any tests into consideration. In comparison, the probability that non-malignant primary hyperparathyroidism would have occurred at the same time as an unrelated non-carcinoma cancer that presents with malignant cells in the parathyroid gland is calculated by multiplying the probabilities of the two. The resultant probability is, however, much smaller than the 1 in 6 million. Therefore, the probability of parathyroid carcinoma may still be close to 100% after histopathologic examination despite the low probability of occurring in the first place.
4471:
important to include those where relatively fast initiation of therapy is most likely to result in the greatest benefit. If an important candidate condition is missed, no method of differential diagnosis will supply the correct conclusion. The need to find more candidate conditions for inclusion increases with the increasing severity of the presentation itself. For example, if the only presentation is a deviating laboratory parameter and all common harmful underlying conditions have been ruled out, then it may be acceptable to stop finding more candidate conditions, but this would much more likely be unacceptable if the presentation would have been severe pain.
2195:(thereby classifying as hypercalcemia) is, by the definition of standard reference range, less than 2.5%. However, this probability can be further specified by considering how much the measurement deviates from the mean in the standard reference range. Let's say that the serum calcium measurement was 1.30 mmol/L, which, with a standard reference range established at 1.05 to 1.25 mmol/L, corresponds to a standard score of 3 and a corresponding probability of 0.14% that such degree of hypercalcemia would have occurred in the first place in the case of no abnormality:
2528:
2915:
663:
3042:
2370:
887:
2785:
2655:
158:
2359:
3364:, treatments or other actions. If there is an indication for an additional test, and it returns with a result, then the procedure is repeated using the likelihood ratio of the additional test. With updated probabilities for each of the candidate conditions, the indications for further tests, treatments, or other actions change as well, and so the procedure can be repeated until an
4488:. A recalculation may therefore be needed, with the first two conditions being separated into "primary hyperparathyroidism without cancer", "cancer without primary hyperparathyroidism" as well as "combined primary hyperparathyroidism and cancer", and likelihood ratios being applied to each condition separately. In this case, however, tissue has already been resected, wherein a
2142:
3240:) as a multiplication factor after each test or procedure. In an ideal world, sensitivities and specificities would be established for all tests for all possible pathological conditions. In reality, however, these parameters may only be established for one of the candidate conditions. Multiplying with likelihood ratios necessitates conversion of likelihoods from
2003:
4518:. Alternatively, it may be seen as "augmented intelligence" if it meets the FDA criteria, namely that (1) it reveals the underlying data, (2) reveals the underlying logic, and (3) leaves the clinician in charge to shape and make the decision. Machine learning AI is generally seen as a device by the FDA, whereas augmented intelligence applications are not.
2796:
1688:
567:
2926:
2523:{\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia WHOIFPI}})\\=&\Pr({\text{hypercalcemia WHOIFPI by PH}})+\Pr({\text{hypercalcemia WHOIFPI by cancer}})\\&{}+\Pr({\text{hypercalcemia WHOIFPI by other conditions}})+\Pr({\text{hypercalcemia WHOIFPI by no disease}})\\=&0.00125+0.0002+0.0005+0.0014=0.00335\end{aligned}}}
772:
2666:
3805:
2539:
761:
2250:
2022:
4483:
To continue the example used above, let's say that the history and physical examination were indicative of cancer as well, with a likelihood ratio of 3, giving an Odds(PostH&E) of 0.057, corresponding to a P(PostH&E) of 5.4%. This would correspond to a "Sum of known P(PostH&E)" of 101.5%.
4256:
Let's say that the patient in this example is revealed to have at least some of the symptoms and signs of depression, bone pain, joint pain or constipation of more severity than what would be expected by the hypercalcemia itself, supporting the suspicion of primary hyperparathyroidism, and let's say
1879:
1388:
for having developed primary hyperparathyroidism can roughly be regarded as being the last half-year because a previously developed hypercalcemia would probably have been caught up by the previous blood test. This corresponds to a probability of primary hyperparathyroidism (PH) in the population of:
967:
4525:
However, these tools all still require advanced medical skills to rate symptoms and choose additional tests to deduce the probabilities of different diagnoses. Machine differential diagnosis is also currently unable to diagnose multiple concurrent disorders. Their usage by non-experts is therefore
4521:
Many studies demonstrate improvement of quality of care and reduction of medical errors by using such decision support systems. Some of these systems are designed for a specific medical problem such as schizophrenia, Lyme disease or ventilator-associated pneumonia. Others are designed to cover all
2008:
The probabilities that hypercalcemia would have occurred in the first place by other candidate conditions can be calculated in a similar manner. However, for simplicity, let's say that the probability that any of these would have occurred in the first place is calculated at 0.0005 in this example.
3393:
This example continues for the same patient as in the example for the epidemiology-based method. As with the previous example of epidemiology-based method, this example case is made to demonstrate how this method is applied but does not represent a guideline for handling similar real-world cases.
4479:
If two conditions get high post-test probabilities, especially if the sum of the probabilities for conditions with known likelihood ratios becomes higher than 100%, then the actual condition is a combination of the two. In such cases, that combined condition can be added to the list of candidate
4470:
The validity of both the initial estimation of probabilities by epidemiology and further workup by likelihood ratios are dependent on the inclusion of candidate conditions that are responsible for a large part as possible of the probability of having developed the condition, and it is clinically
4260:
The presence of unspecific pathologic symptoms and signs in the history and examination are often concurrently indicative of cancer as well, and let's say that the tests gave an overall likelihood ratio estimated at 1.5 for cancer. For other conditions, as well as the instance of not having any
1379:
Let's say that the last blood test taken by the patient was half a year ago and was normal and that the incidence of primary hyperparathyroidism in a general population appropriately matches the individual (except for the presentation and mentioned heredity) is 1 in 4000 per year. Ignoring more
528:
One method of performing a differential diagnosis by epidemiology aims to estimate the probability of each candidate condition by comparing their probabilities to have occurred in the first place in the individual. It is based on probabilities related both to the presentation (such as pain) and
512:
A diagnostician can be selective, considering first those disorders that are more likely (a probabilistic approach), more serious if left undiagnosed and untreated (a prognostic approach), or more responsive to treatment if offered (a pragmatic approach). Since the subjective probability of the
3368:
where there no longer is any indication for currently performing further actions. Such an endpoint mainly occurs when one candidate condition becomes so certain that no test can be found that is powerful enough to change the relative probability profile enough to motivate any change in further
4568:
to identify and classify organisms, living and extinct. For example, after finding an unknown species, there can first be a listing of all potential species, followed by ruling out of one by one until, optimally, only one potential choice remains. Similar procedures may be used by plant and
4065:
139:
Strategies used in preparing a differential diagnosis list vary with the experience of the healthcare provider. While novice providers may work systemically to assess all possible explanations for a patient's concerns, those with more experience often draw on clinical experience and pattern
1894:
3385:, potentially bringing the probabilities for competing candidate conditions to negligible levels. If such negligible probabilities are achieved, the clinician can rule out these conditions, and continue the differential diagnostic procedure with only the remaining candidate conditions.
4165:
476:
There are several methods for differential diagnostic procedures and several variants among those. Furthermore, a differential diagnostic procedure can be used concomitantly or alternately with protocols, guidelines, or other diagnostic procedures (such as pattern recognition or using
1570:
4229:
These "new" percentages, including a profile-relative probability of 80% for primary hyperparathyroidism, underlie any indications for further tests, treatments, or other actions. In this case, let's say that the clinician continues the plan for the patient to attend a clinician
2910:{\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is caused by other conditions in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by other conditions}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.0005}{0.00335}}=0.149=14.9\%,\end{aligned}}}
3613:
3462:
For simplicity, let's say that the clinician first receives the blood test (in formulas abbreviated as "BT") result for the parathyroid hormone analysis and that it showed a parathyroid hormone level that is elevated relative to what would be expected by the calcium level.
658:{\displaystyle {\begin{aligned}&{\frac {\Pr({\text{Presentation is caused by condition in individual}})}{\Pr({\text{Presentation has occurred in individual}})}}={\frac {\Pr({\text{Presentation WHOIFPI by condition}})}{\Pr({\text{Presentation WHOIFPI}})}}\end{aligned}}}
3037:{\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is present despite no disease in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by no disease}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.0014}{0.00335}}=0.418=41.8\%\end{aligned}}}
1585:
3204:
The procedure of differential diagnosis can become extremely complex when fully taking additional tests and treatments into consideration. One method that is somewhat a tradeoff between being clinically perfect and being relatively simple to calculate is one that uses
3436:
These percentages could also have been established by experience at the particular clinic by knowing that these are the percentages for final diagnosis for people presenting to the clinic with hypercalcemia and having a family history of primary hyperparathyroidism.
3192:
Thus, this method estimates that the probability that the hypercalcemia is caused by primary hyperparathyroidism, cancer, other conditions or no disease at all are 37.3%, 6.0%, 14.9%, and 41.8%, respectively, which may be used in estimating further test indications.
1766:
882:{\displaystyle {\begin{aligned}\Pr({\text{Presentation WHOIFPI}})&=\Pr({\text{Presentation WHOIFPI by condition 1}})\\&{}+\Pr({\text{Presentation WHOIFPI by condition 2}})\\&{}+\Pr({\text{Presentation WHOIFPI by condition 3}})+{\text{etc.}}\end{aligned}}}
1458:
1069:
4552:"Differential diagnosis" is also used more loosely to refer simply to a list of the most common causes of a given symptom, to a list of disorders similar to a given disorder, or to such lists when they are annotated with advice on how to narrow the list down (
2780:{\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is caused by cancer in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by cancer}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.0002}{0.00335}}=0.060=6.0\%,\end{aligned}}}
279:
Perform tests to determine the actual diagnosis. This is known by the colloquial phrase "to Rule Out". Even after the process, the diagnosis is not clear. The clinician again considers the risks and may treat them empirically, often called "Educated Best
1771:
For simplicity, let's say that any association between a family history of primary hyperparathyroidism and risk of cancer is ignored, so the relative risk for the individual to have contracted cancer in the first place is similar to that of the population
992:
The probability that a condition would have occurred in the first place in an individual is approximately equal to that of a population that is as similar to the individual as possible except for the current presentation, compensated where possible by
2650:{\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is caused by PH in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by PH}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.00125}{0.00335}}=0.373=37.3\%\end{aligned}}}
3662:
3352:
The rest of the candidate conditions (for which there is no established likelihood ratio for the test at hand) can, for simplicity, be adjusted by subsequently multiplying all candidate conditions with a common factor to again yield a sum of 100%.
696:
3394:
Also, the example uses relatively specified numbers, while in reality, there are often just rough estimations. In this example, the probabilities for each candidate condition were established by an epidemiology-based method to be as follows:
2354:{\displaystyle {\begin{aligned}&\Pr({\text{Hypercalcemia WHOIFPI by no disease}})\\=&\Pr({\text{no disease WHOIFPI}})\cdot r_{{\text{no disease}}\rightarrow {\text{hypercalcemia}}}\\=&0.997\cdot 0.0014\approx 0.0014\end{aligned}}}
3444:(PH), but cancer is still of major concern, because if it is the actual causative condition for the hypercalcemia, then the choice of whether to treat or not likely means life or death for the patient, in effect potentially putting the
2137:{\displaystyle {\begin{aligned}\Pr({\text{no disease in population}})&=1-\Pr({\text{PH in population}})-\Pr({\text{cancer in population}})\\&{}\quad -\Pr({\text{other conditions in population}})\\&{}=0.997.\end{aligned}}}
1782:
4448:, and the physician thereby practically regards "other conditions" as ruled out, in this case not primarily by any specific test for such other conditions that were negative, but rather by the absence of positive tests so far.
898:
3296:
1463:
With the relative risk conferred from the family history, the probability that primary hyperparathyroidism (PH) would have occurred in the first place in the individual given from the currently available information becomes:
2239:
1998:{\displaystyle {\begin{aligned}&\Pr({\text{Hypercalcemia WHOIFPI by cancer}})\\=&\Pr({\text{cancer WHOIFPI}})\cdot r_{{\text{cancer}}\rightarrow {\text{hypercalcemia}}}\\=&0.002\cdot 0.1=0.0002.\end{aligned}}}
3976:
3965:
1253:
One additional "candidate condition" is the instance of there being no abnormality, and the presentation is only a (usually relatively unlikely) appearance of a basically normal state. Its probability in the population
5127:
4261:
disease at all, let's say that it is unknown how they are affected by the tests at hand, as often happens in reality. This gives the following results for the history and physical examination (abbreviated as P&E):
3347:
140:
recognition to protect the patient from delays, risks, and cost of inefficient strategies or tests. Effective providers utilize an evidence-based approach, complementing their clinical experience with knowledge from
106:, or at least a process of obtaining information that decreases the "probabilities" of candidate conditions to negligible levels, by using evidence such as symptoms, patient history, and medical knowledge to adjust
553:) is still 1/6. In the same way, the probability that a presentation or condition would have occurred in the first place in an individual (WHOIFPI) is not same as the probability that the presentation or condition
4076:
1470:
689:
When an individual presents with a symptom or sign, Pr(Presentation has occurred in individual) is 100% and can therefore be replaced by 1, and can be ignored since division by 1 does not make any difference:
1266:
This example case demonstrates how this method is applied but does not represent a guideline for handling similar real-world cases. Also, the example uses relatively specified numbers with sometimes several
3885:
3502:
1683:{\displaystyle {\begin{aligned}\Pr({\text{Hypercalcemia WHOIFPI by PH}})&=\Pr({\text{PH WHOIFPI}})\cdot r_{{\text{PH}}\rightarrow {\text{hypercalcemia}}}\\&=0.00125\cdot 1=0.00125\end{aligned}}}
3451:
Here, let's say that the clinician considers the profile-relative probabilities of being of enough concern to indicate sending the patient a call for a clinician visit, with an additional visit to the
2186:
2931:
2801:
2671:
2544:
2375:
2255:
2027:
1899:
1703:
1590:
777:
572:
892:
Also, the probability of the presentation to have been caused by any candidate condition is proportional to the probability of the condition, depending on what rate it causes the presentation:
5249:
1395:
5120:
1007:
4444:
At this point, the probability of "other conditions" is so low that the physician cannot think of any test for them that could make a difference that would be substantial enough to form an
1697:, the same time-at-risk is assumed for simplicity, and let's say that the incidence of cancer in the area is estimated at 1 in 250 per year, giving a population probability of cancer of:
4451:
For "cancer", the cutoff at which to confidently regard it as ruled out maybe more stringent because of severe consequences of missing it, so the physician may consider that at least a
1308:, which becomes the "presentation" in this case. A clinician (who becomes the "diagnostician" in this example), who does not currently see the patient, gets to know about his finding.
5113:
3800:{\displaystyle \Pr({\text{PostBT}}_{PH})={\frac {\operatorname {Odds} ({\text{PostBT}}_{PH})}{\operatorname {Odds} ({\text{PostBT}}_{PH})+1}}={\frac {4.16}{4.16+1}}=0.806=80.6\%}
128:, where two different diagnoses can be attached to a patient who is exhibiting symptoms that could fit into either diagnosis. For example, a patient who has been diagnosed with
3228:, such as statistically knowing that patients coming into a particular clinic with a particular complaint statistically has a particular likelihood of each candidate condition.
1579:= 1), so this independently calculated probability of primary hyperparathyroidism (PH) can be assumed to be the same as the probability of being a cause of the presentation:
1342:
The clinician considers that there is enough motivation to perform a differential diagnostic procedure for the finding of hypercalcemia. The main causes of hypercalcemia are
756:{\displaystyle \Pr({\text{Presentation is caused by condition in individual}})={\frac {\Pr({\text{Presentation WHOIFPI by condition}})}{\Pr({\text{Presentation WHOIFPI}})}}}
492:(airway, breathing and circulation) may be more appropriate. Later, when the situation is less acute, a more comprehensive differential diagnostic procedure may be adopted.
79:, or, at least, to consider any imminently life-threatening conditions. Often, each individual option of a possible disease is called a differential diagnosis (e.g., acute
4918:
Bargren, A. E.; Repplinger, D.; Chen, H.; Sippel, R. S. (2011). "Can
Biochemical Abnormalities Predict Symptomatology in Patients with Primary Hyperparathyroidism?".
1098:
Pr(Condition in population) is the probability that the condition occurs in a population that is as similar to the individual as possible except for the presentation
117:, in the sense that the potential presence of candidate diseases or conditions can be viewed as hypotheses that clinicians further determine as being true or false.
5242:
5038:"Evaluation of a Computer Assisted Decision Support System (DSS) for Diagnosis and Treatment of Ventilator Associated Pneumonia (VAP) in Intensive Care Unit (ICU)"
679:
Pr(Presentation has occurred in individual) is the probability that the presentation has occurred in the individual, which can be perceived and thereby set at 100%
3301:
However, only the candidate conditions with known likelihood ratio need this conversion. After multiplication, conversion back to probability is calculated by:
1874:{\displaystyle \Pr({\text{cancer WHOIFPI}})\approx RR_{\text{cancer}}\cdot \Pr({\text{cancer in population}})=1\cdot {\frac {1}{500}}={\frac {1}{500}}=0.002.}
962:{\displaystyle \Pr({\text{Presentation WHOIFPI by condition}})=\Pr({\text{Condition WHOIFPI}})\cdot r_{{\text{condition}}\rightarrow {\text{presentation}}},}
4770:
5067:
Wadhwa, R.R.; Park, D.Y.; Natowicz, M.R. (2018). "The accuracy of computer-based diagnostic tools for the identification of concurrent genetic disorders".
5235:
4787:
Richardson, WS. (March 1999). "Users' Guides to the
Medical Literature: XV. How to use an article about disease probability for differential diagnosis".
3256:
4484:
This is an indication for considering a combination of primary hyperparathyroidism and cancer, such as, in this case, a parathyroid hormone-producing
2201:
4060:{\displaystyle {\text{Correcting factor}}={\frac {\Pr({\text{PostBT}}_{\text{rest}})}{\Pr({\text{PreBT}}_{\text{rest}})}}={\frac {19.4}{62.7}}=0.309}
513:
presence of a condition is never exactly 100% or 0%, the differential diagnostic procedure may aim at specifying these various probabilities to form
976:
Pr(Presentation WHOIFPI by condition) is the probability that the presentation Would Have
Occurred in the First Place in the Individual by condition
766:
The total probability of the presentation to have occurred in the individual can be approximated as the sum of the individual candidate conditions:
682:
Pr(Presentation WHOIFPI by condition) is the probability that the presentation Would Have
Occurred in the First Place in the Individual by condition
3896:
3233:
3206:
175:
3307:
4515:
4160:{\displaystyle \Pr({\text{PostBT}}_{\text{cancer}})=\Pr({\text{PreBT}}_{\text{cancer}})\cdot {\text{Correcting factor}}=6.0\%\cdot 0.309=1.9\%}
988:
is the rate at which a condition causes the presentation, that is, the fraction of people with conditions that manifests with the presentation.
1565:{\displaystyle \Pr({\text{PH WHOIFPI}})\approx RR_{PH}\cdot \Pr({\text{PH in population}})=10\cdot {\frac {1}{8000}}={\frac {1}{800}}=0.00125}
561:
occurred by 100% certainty in the individual. Yet, the contributive probability fractions of each condition are assumed the same, relatively:
5037:
4672:
3970:
Therefore, to conform to a sum of 100% for all candidate conditions, each of the other candidates must be multiplied by a correcting factor:
3492:
means before). It was estimated at 37.3%, corresponding to an odds of 0.595. With the likelihood ratio positive of 7 for the blood test, the
5695:
672:
Pr(Presentation is caused by condition in individual) is the probability that the presentation is caused by condition in the individual;
5713:
5636:
4257:
that the likelihood ratios for the tests, when multiplied together, roughly results in a product of 6 for primary hyperparathyroidism.
2533:
Subsequently, the probability that hypercalcemia is caused by primary hyperparathyroidism (PH) in the individual can be calculated as:
5204:
5007:
4751:
4724:
5624:
5535:
3816:
3608:{\displaystyle \operatorname {Odds} ({\text{PostBT}}_{PH})=\operatorname {Odds} ({\text{PreBT}}_{PH})\cdot LH(BT)=0.595\cdot 7=4.16,}
222:
4697:
4437:
These probabilities after the history and examination may make the physician confident enough to plan the patient for surgery for a
1327:(here abbreviated as PH), which may explain the finding of hypercalcemia. For this patient, let's say that the resultant hereditary
241:
3377:
for such tests is very high, bringing all less likely conditions to relatively lower probabilities. Alternatively, tests with high
194:
5708:
4614:
4505:
4492:
can be performed that includes the possibility of parathyroid carcinoma in the examination (which may entail appropriate sample
276:
Prioritize the list by balancing the risks of a diagnosis with the probability. These are subjective, not objective parameters.
110:
confidences in the mind of the diagnostician (or, for computerized or computer-assisted diagnosis, the software of the system).
5657:
5517:
2153:
133:
201:
5283:
4556:
is an example). Thus, a differential diagnosis in this sense is medical information specially organized to aid in diagnosis.
179:
1761:{\displaystyle \Pr({\text{cancer in population}})=0.5{\text{ years}}\cdot {\frac {1}{\text{250 per year}}}={\frac {1}{500}}}
501:" sign or symptom is found (in which case it is almost certain that the target condition is present) or in the absence of a
488:, there may not be enough time to do any detailed calculations or estimations of different probabilities, in which case the
4638:
5208:
1453:{\displaystyle \Pr({\text{PH in population}})=0.5{\text{ years}}\cdot {\frac {1}{\text{4000 per year}}}={\frac {1}{8000}}}
1381:
685:
Pr(Presentation WHOIFPI) is the probability that the presentation Would Have
Occurred in the First Place in the Individual
520:
The following are two methods of differential diagnosis, being based on epidemiology and likelihood ratios, respectively.
4952:
1362:
Other diseases that the clinician could think of (which is simply termed "other conditions" for the rest of this example)
5761:
1312:
1064:{\displaystyle \Pr({\text{Condition WHOIFPI}})\approx RR_{\text{condition}}\cdot \Pr({\text{Condition in population}}),}
208:
114:
2364:
The probability that hypercalcemia would have occurred in the first place in the individual can thus be calculated as:
4445:
4269:
4178:
3471:
3467:
3441:
3402:
3378:
3370:
3237:
1343:
1324:
4253:
of the next. The indications for choosing the next test are dynamically influenced by the results of previous tests.
2191:
The rate at which the case of no abnormal condition still ends up in measurement of serum calcium of being above the
2016:, the corresponding probability in the population is complementary to the sum of probabilities for other conditions:
67:
or condition from others that present with similar clinical features. Differential diagnostic procedures are used by
1078:
Pr(Condition WHOIFPI) is the probability that the condition Would Have
Occurred in the First Place in the Individual
979:
Pr(Condition WHOIFPI) is the probability that the condition Would Have
Occurred in the First Place in the Individual
5771:
5766:
5504:
450:
190:
1372:
The probability that 'primary hyperparathyroidism' (PH) would have occurred in the first place in the individual (
168:
5631:
5619:
5320:
5315:
4767:
3645:
3475:
3382:
3374:
1320:
5611:
4619:
2192:
1301:
29:
4569:
maintenance engineers and automotive mechanics and used to be used in diagnosing faulty electronic circuitry.
4170:
The probabilities for each candidate conditions before and after the blood test are given in following table:
3369:
actions. Tactics for reaching such an endpoint with as few tests as possible includes making tests with high
5703:
5486:
1366:
2244:
Subsequently, the probability that hypercalcemia would have resulted from no disease can be calculated as:
5675:
5105:
4604:
2660:
Similarly, the probability that hypercalcemia is caused by cancer in the individual can be calculated as:
374:
103:
4534:
The method of differential diagnosis was first suggested for use in the diagnosis of mental disorders by
1350:, so for simplicity, the list of candidate conditions that the clinician could think of can be given as:
5547:
5396:
4485:
4246:
3445:
3357:
514:
346:
2147:
The probability that the individual would be healthy in the first place can be assumed to be the same:
1102:
The following table demonstrates how these relations can be made for a series of candidate conditions:
4564:
Methods similar to those of differential diagnostic processes in medicine are also used by biological
4237:
A clinician visit can, theoretically, be regarded as a series of tests, including both questions in a
5591:
5530:
5381:
5363:
5310:
5258:
5212:
4522:
major clinical and diagnostic findings to assist physicians with faster and more accurate diagnosis.
4250:
4242:
337:
255:
215:
5727:
5512:
5457:
5325:
5137:
3456:
3225:
3217:
The initial likelihoods for each candidate condition can be estimated by various methods, such as:
393:
5045:
5685:
5667:
5560:
5494:
5293:
5153:
5092:
4812:
4565:
3638:
is the odds in favor of primary hyperparathyroidism before the blood test for parathyroid hormone
3452:
1575:
Primary hyperparathyroidism can be assumed to cause hypercalcemia essentially 100% of the time (r
460:
403:
4879:"Clinical performance of a parathyrin immunoassay with dynamically determined reference values"
83:
could be a differential diagnosis in the evaluation of a cough, even if the final diagnosis is
5735:
5439:
5288:
5191:
5170:
5084:
5019:
4988:
4935:
4900:
4855:
4804:
4747:
4720:
4693:
4668:
4665:
Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
4587:
4581:
4511:
4438:
4231:
538:
485:
478:
441:
431:
141:
95:
72:
5581:
5429:
5414:
5187:
5076:
4978:
4927:
4890:
4845:
4821:
4796:
3373:
for conditions of already outstandingly high-profile-relative probability, because the high
298:
129:
3810:
The sum of the probabilities for the rest of the candidate conditions should therefore be:
1271:, while in reality, there are often simply rough estimations, such as of likelihoods being
5586:
5447:
5278:
5270:
5262:
4774:
4540:
4238:
509:
sign or symptom (in which case it is almost certain that the target condition is absent).
5227:
102:
where multiple alternatives are possible. This method may employ algorithms, akin to the
4864:
3629:
is the odds for primary hyperparathyroidism after the blood test for parathyroid hormone
3047:
For clarification, these calculations are given as the table in the method description:
1319:. For simplicity, let's say that the only information given in the medical records is a
5565:
5452:
5424:
5338:
4850:
4833:
4609:
4535:
4489:
4452:
1316:
489:
99:
4931:
4590:
leads a team of diagnosticians who regularly use differential diagnostics procedures.
5755:
5330:
4877:
Lepage, R.; d'Amour, P.; Boucher, A.; Hamel, L.; Demontigny, C.; Labelle, F. (1988).
4578:
3246:
3241:
1332:
1305:
1297:
1088:
994:
497:
5096:
4983:
4966:
3890:
Before the blood test for parathyroid hormone, the sum of their probabilities were:
5522:
5464:
5386:
4816:
3361:
3196:
This case is continued in the example of the method described in the next section.
1385:
1258:) is complementary to the sum of probabilities of "abnormal" candidate conditions.
504:
308:
107:
4895:
4878:
3291:{\displaystyle {\text{odds}}={\frac {\text{probability}}{1-{\text{probability}}}}}
4965:
Razzouk, D.; Mari, J. J.; Shirakawa, I.; Wainer, J.; Sigulem, D. (January 2006).
4741:
4714:
1380:
detailed retrospective analyses (such as including speed of disease progress and
35:
5652:
5601:
5406:
4599:
2234:{\displaystyle r_{{\text{no disease}}\rightarrow {\text{hypercalcemia}}}=0.0014}
1328:
1092:
998:
157:
84:
3440:
The condition of highest profile-relative probability (except "no disease") is
5555:
5474:
5469:
5419:
5303:
1293:
383:
365:
327:
317:
125:
121:
80:
68:
4800:
1884:
However, hypercalcemia only occurs in, very approximately, 10% of cancers, (r
5391:
5348:
5178:
4716:
Differential diagnosis in internal medicine : from symptom to diagnosis
3960:{\displaystyle \Pr({\text{PreBT}}_{\text{rest}})=6.0\%+14.9\%+41.8\%=62.7\%}
5088:
5023:
4992:
4939:
4859:
4808:
4667:. Washington, DC, USA: American Psychiatric Publishing. pp. 150, 158.
4514:
to partly or fully make a differential diagnosis. It may be regarded as an
3455:
for an additional blood test complemented with further analyses, including
3342:{\displaystyle {\text{probability}}={\frac {\text{odds}}{{\text{odds}}+1}}}
4904:
4866:
4234:
for a further checkup, especially focused on primary hyperparathyroidism.
1233:
Pr(Presentation WHOIFPI) = the sum of the probabilities in row just above
5680:
5157:
5080:
4493:
421:
285:
264:
Gather relevant information about the patient and create a symptoms list.
182: in this paragraph. Unsourced material may be challenged and removed.
4070:
For example, the probability of cancer after the test is calculated as:
5298:
5161:
4480:
conditions, and the calculations should start over from the beginning.
1268:
545:
has landed the outcome is certain by 100%, but the probability that it
412:
76:
64:
4967:"Decision support system for the diagnosis of schizophrenia disorders"
4690:
The
Patient History: Evidence-Based Approach To Differential Diagnosis
4538:. It is more systematic than the old-fashioned method of diagnosis by
3493:
1365:
No disease (or no abnormality), and the finding is caused entirely by
529:
probabilities of the various candidate conditions (such as diseases).
113:
Differential diagnosis can be regarded as implementing aspects of the
45:
5343:
3474:
of approximately 90% for primary hyperparathyroidism. This confers a
1347:
260:
A differential diagnosis has four general steps. The clinician will:
3488:
because it corresponds to before the blood test (Latin preposition
3448:
at a similar level for further tests for both of these conditions.
3232:
One method of estimating likelihoods even after further tests uses
1311:
By practical reasons, the clinician considers that there is enough
288:
to help in considering multiple possible pathological processes is
120:
A differential diagnosis is also commonly used within the field of
5596:
3656:) of 4.16 is again converted to the corresponding probability by:
355:
16:
Method of analysis of a patient's history and physical examination
5006:
Hejlesen OK, Olesen KG, Dessau R, Beltoft I, Trangeled M (2005).
1292:
For an individual (who becomes the "patient" in this example), a
5373:
5195:
542:
5231:
5109:
3880:{\displaystyle \Pr({\text{PostBT}}_{rest})=100\%-80.6\%=19.4\%}
676:
without further specification refers to any candidate condition
495:
The differential diagnostic procedure may be simplified if a "
151:
3481:
The probability of primary hyperparathyroidism is now termed
4740:
Lim, Eric KS; Oster, Andrew JK; Rafferty, Andrew T (2014).
136:, given the similarity in the symptoms of both conditions.
63:) is a method of analysis that distinguishes a particular
2945:
hypercalcemia is present despite no disease in individual
2815:
hypercalcemia is caused by other conditions in individual
2181:{\displaystyle \Pr({\text{no disease WHOIFPI}})=0.997.\,}
3356:
The resulting probabilities are used for estimating the
1289:, but still using the general principles of the method.
1247:
Pr(Presentation is caused by condition 3 in individual)
1095:
in the individual that are not present in the population
4955:
at
National Cancer Institute. Last Modified: 03/11/2009
2920:
and the probability that there actually is no disease:
1244:
Pr(Presentation is caused by condition 2 in individual)
1241:
Pr(Presentation is caused by condition 1 in individual)
4079:
3979:
3899:
3819:
3665:
3505:
3310:
3259:
3221:
By epidemiology as described in the previous section.
3174:
P(hypercalcemia is caused by condition in individual)
2929:
2799:
2669:
2542:
2373:
2253:
2204:
2156:
2025:
1897:
1785:
1706:
1588:
1473:
1398:
1238:
Pr(Presentation is caused by condition in individual)
1010:
1001:
that distinguish the individual from the population:
901:
775:
699:
570:
557:
occurred in the individual, because the presentation
4971:
Brazilian Journal of Medical and Biological Research
537:
The statistical basis for differential diagnosis is
273:) for the symptoms. The list need not be in writing.
5726:
5694:
5666:
5645:
5610:
5574:
5546:
5503:
5485:
5438:
5405:
5371:
5362:
5269:
28:
23:
4159:
4059:
3959:
3879:
3799:
3607:
3459:for the suspicion of primary hyperparathyroidism.
3341:
3290:
3036:
2909:
2779:
2649:
2522:
2353:
2233:
2180:
2136:
1997:
1873:
1760:
1682:
1564:
1452:
1063:
961:
881:
755:
657:
708:Presentation is caused by condition in individual
587:Presentation is caused by condition in individual
5008:"Decision support for diagnosis of lyme disease"
4743:Churchill's pocketbook of differential diagnosis
4104:
4080:
4014:
3991:
3900:
3820:
3666:
3466:Such a constellation can be estimated to have a
2979:
2963:
2937:
2849:
2833:
2807:
2719:
2703:
2677:
2592:
2576:
2550:
2466:
2449:
2423:
2406:
2381:
2286:
2261:
2157:
2101:
2074:
2057:
2030:
1930:
1905:
1819:
1786:
1707:
1614:
1593:
1510:
1474:
1399:
1044:
1011:
919:
902:
853:
827:
801:
780:
736:
720:
700:
634:
618:
595:
579:
4768:VINDICATE – Mnemonic for differential diagnosis
3381:for competing candidate conditions have a high
2685:hypercalcemia is caused by cancer in individual
4663:American Psychiatric Association, ed. (2022).
132:may also be given a differential diagnosis of
5243:
5121:
4746:(Fourth ed.). Elsevier Health Sciences.
4526:not a substitute for professional diagnosis.
4510:Machine differential diagnosis is the use of
8:
5012:Studies in Health Technology and Informatics
3209:to derive subsequent post-test likelihoods.
1304:, which, by most definitions, classifies as
5069:American Journal of Medical Genetics Part A
4920:Journal of the American College of Surgeons
2558:hypercalcemia is caused by PH in individual
5368:
5250:
5236:
5228:
5147:
5128:
5114:
5106:
3648:for the blood test for parathyroid hormone
4982:
4894:
4849:
4458:This case is continued in the example of
4128:
4116:
4111:
4092:
4087:
4078:
4041:
4026:
4021:
4003:
3998:
3988:
3980:
3978:
3912:
3907:
3898:
3832:
3827:
3818:
3764:
3740:
3735:
3711:
3706:
3693:
3678:
3673:
3664:
3551:
3546:
3521:
3516:
3504:
3325:
3319:
3311:
3309:
3280:
3268:
3260:
3258:
3005:
2985:
2969:
2960:
2943:
2930:
2928:
2875:
2855:
2841:hypercalcemia WHOIFPI by other conditions
2839:
2830:
2813:
2800:
2798:
2745:
2725:
2709:
2700:
2683:
2670:
2668:
2618:
2598:
2582:
2573:
2556:
2543:
2541:
2472:
2457:hypercalcemia WHOIFPI by other conditions
2455:
2444:
2429:
2412:
2387:
2374:
2372:
2316:
2308:
2307:
2292:
2267:
2254:
2252:
2218:
2210:
2209:
2203:
2177:
2163:
2155:
2122:
2107:
2095:
2080:
2063:
2036:
2026:
2024:
1960:
1952:
1951:
1936:
1911:
1898:
1896:
1855:
1842:
1825:
1810:
1792:
1784:
1748:
1735:
1727:
1713:
1705:
1644:
1636:
1635:
1620:
1599:
1589:
1587:
1546:
1533:
1516:
1498:
1480:
1472:
1440:
1427:
1419:
1405:
1397:
1050:
1035:
1017:
1009:
949:
941:
940:
925:
908:
900:
870:
859:
848:
833:
822:
807:
786:
776:
774:
742:
726:
717:
706:
698:
640:
624:
615:
601:
585:
576:
571:
569:
242:Learn how and when to remove this message
4554:French's Index of Differential Diagnosis
4396:
4388:
4380:
4372:
4263:
4172:
3396:
3049:
1228:Pr(Presentation WHOIFPI by condition 3)
1104:
4630:
4249:of a previous test, can be used as the
1225:Pr(Presentation WHOIFPI by condition 2)
1222:Pr(Presentation WHOIFPI by condition 1)
603:Presentation has occurred in individual
4516:application of artificial intelligence
3478:of 7 for primary hyperparathyroidism.
547:Would Have Occurred in the First Place
20:
4455:of the resected tissue is indicated.
3250:(hereafter simply termed "odds") by:
3148:P(hypercalcemia WHOIFPI by condition)
1219:Pr(Presentation WHOIFPI by condition)
7:
4643:Merriam-Webster (Medical dictionary)
4462:in the corresponding section below.
2790:and for other candidate conditions:
180:adding citations to reliable sources
5637:Upper limb neurological examination
5140:used to describe disease conditions
2971:hypercalcemia WHOIFPI by no disease
2474:hypercalcemia WHOIFPI by no disease
2269:Hypercalcemia WHOIFPI by no disease
861:Presentation WHOIFPI by condition 3
835:Presentation WHOIFPI by condition 2
809:Presentation WHOIFPI by condition 1
98:used to identify the presence of a
41:
4154:
4139:
3954:
3945:
3936:
3927:
3874:
3865:
3856:
3794:
3027:
2897:
2767:
2640:
14:
4932:10.1016/j.jamcollsurg.2011.06.401
1091:for condition conferred by known
910:Presentation WHOIFPI by condition
728:Presentation WHOIFPI by condition
626:Presentation WHOIFPI by condition
92:differential diagnostic procedure
4615:Gender-bias in medical diagnosis
4506:Clinical decision support system
4466:Coverage of candidate conditions
2012:For the instance of there being
1376:) can be calculated as follows:
1355:Primary hyperparathyroidism (PH)
1315:to have a look at the patient's
156:
5658:Ballard Maturational Assessment
5518:Peripheral vascular examination
4984:10.1590/s0100-879x2006000100014
4441:to resect the affected tissue.
3238:sensitivities and specificities
2711:hypercalcemia WHOIFPI by cancer
2431:hypercalcemia WHOIFPI by cancer
2097:
1913:Hypercalcemia WHOIFPI by cancer
1256:P(No abnormality in population)
167:needs additional citations for
134:borderline personality disorder
5284:History of the present illness
4834:"Cancer-related hypercalcemia"
4832:Seccareccia, D. (March 2010).
4500:Machine differential diagnosis
4378:Sum of the rest P(PostH&E)
4122:
4107:
4098:
4083:
4032:
4017:
4009:
3994:
3918:
3903:
3847:
3823:
3749:
3731:
3720:
3702:
3687:
3669:
3581:
3572:
3560:
3542:
3530:
3512:
2990:
2982:
2974:
2966:
2948:
2940:
2860:
2852:
2844:
2836:
2818:
2810:
2730:
2722:
2714:
2706:
2688:
2680:
2603:
2595:
2587:
2579:
2561:
2553:
2477:
2469:
2460:
2452:
2434:
2426:
2417:
2409:
2392:
2384:
2313:
2297:
2289:
2272:
2264:
2215:
2168:
2160:
2112:
2109:other conditions in population
2104:
2085:
2077:
2068:
2060:
2041:
2033:
1957:
1941:
1933:
1916:
1908:
1830:
1822:
1797:
1789:
1718:
1710:
1641:
1625:
1617:
1604:
1596:
1521:
1513:
1485:
1477:
1410:
1402:
1130:Pr(Condition 3 in population)
1055:
1047:
1022:
1014:
946:
930:
922:
913:
905:
864:
856:
838:
830:
812:
804:
791:
783:
747:
739:
731:
723:
711:
703:
645:
637:
629:
621:
606:
598:
590:
582:
1:
5625:Mini–mental state examination
5536:Ankle–brachial pressure index
4713:Siegenthaler, Walter (2011).
4692:. New York, NY: McGraw Hill.
4386:Sum of the rest P(PreH&E)
4241:, as well as components of a
3200:Likelihood ratio-based method
1382:lag time of medical diagnosis
1127:Pr(Condition 2 in population)
1124:Pr(Condition 1 in population)
4953:Parathyroid Cancer Treatment
4560:Usage apart from in medicine
4548:Alternative medical meanings
3496:test odds is calculated as:
115:hypothetico-deductive method
4896:10.1093/clinchem/34.12.2439
4577:In the American television
4490:histopathologic examination
4453:histopathologic examination
4370:Sum of known P(PostH&E)
4319:Likelihood ratio by H&E
3470:of approximately 70% and a
3442:primary hyperparathyroidism
2584:hypercalcemia WHOIFPI by PH
2414:hypercalcemia WHOIFPI by PH
1601:Hypercalcemia WHOIFPI by PH
1344:primary hyperparathyroidism
1325:primary hyperparathyroidism
1121:Pr(Condition in population)
5788:
4503:
4446:indication for such a test
3070:P(Condition in population)
1213:Condition 3 → presentation
1205:Condition 2 → presentation
1197:Condition 1 → presentation
253:
75:the specific disease in a
5632:Cranial nerve examination
5145:
3646:likelihood ratio positive
3476:likelihood ratio positive
3383:likelihood ratio negative
3375:likelihood ratio positive
3165:
1331:is estimated to confer a
1300:shows a result above the
1232:
524:Epidemiology-based method
42:
4801:10.1001/jama.281.13.1214
4773:20 December 2012 at the
4639:"differential diagnosis"
4620:List of medical symptoms
3167:P(hypercalcemia WHOIFPI)
3129:Condition →hypercalcemia
2193:standard reference range
2038:no disease in population
1302:standard reference range
1189:Condition → presentation
986:Condition → presentation
541:. As an analogy, when a
484:For example, in case of
191:"Differential diagnosis"
5704:Athletic heart syndrome
5209:Acronym or abbreviation
4586:, the main protagonist
3236:(which is derived from
1367:statistical variability
1175:Pr(Condition 2 WHOIFPI)
1172:Pr(Condition 1 WHOIFPI)
1052:Condition in population
549:(hereafter abbreviated
5741:Differential diagnosis
5676:Well-woman examination
5175:Differential diagnosis
4605:Diagnosis of exclusion
4389:4.6% + 12.9% = 17.5%
4161:
4061:
3961:
3881:
3801:
3609:
3343:
3292:
3038:
2911:
2781:
2651:
2524:
2355:
2235:
2182:
2138:
1999:
1886:cancer → hypercalcemia
1875:
1762:
1684:
1566:
1454:
1179:P(Condition 3 WHOIFPI)
1116:Candidate condition 3
1065:
963:
883:
757:
659:
267:List possible causes (
104:process of elimination
57:differential diagnosis
24:Differential diagnosis
4719:. Thieme. p. 6.
4504:Further information:
4486:parathyroid carcinoma
4397:1.1% / 17.5% = 0.063
4247:post-test probability
4162:
4062:
3962:
3882:
3802:
3610:
3344:
3293:
3039:
2987:hypercalcemia WHOIFPI
2912:
2857:hypercalcemia WHOIFPI
2782:
2727:hypercalcemia WHOIFPI
2652:
2600:hypercalcemia WHOIFPI
2525:
2389:hypercalcemia WHOIFPI
2356:
2236:
2183:
2139:
2000:
1876:
1763:
1685:
1567:
1455:
1169:Pr(Condition WHOIFPI)
1113:Candidate condition 2
1110:Candidate condition 1
1066:
964:
884:
758:
660:
254:Further information:
5709:Sudden cardiac death
5592:Shoulder examination
5531:Abdominojugular test
5364:Physical examination
5311:Past medical history
5081:10.1002/ajmg.a.40651
4251:pre-test probability
4243:physical examination
4077:
3977:
3897:
3817:
3663:
3503:
3308:
3257:
3109:P(Condition WHOIFPI)
2927:
2797:
2667:
2540:
2371:
2251:
2202:
2154:
2082:cancer in population
2023:
1895:
1827:cancer in population
1783:
1715:cancer in population
1704:
1586:
1471:
1396:
1008:
899:
788:Presentation WHOIFPI
773:
744:Presentation WHOIFPI
697:
642:Presentation WHOIFPI
568:
517:for further action.
270:candidate conditions
256:Diagnostic procedure
176:improve this article
5762:Medical terminology
5728:Assessment and plan
5513:Cardiac examination
5458:Swinging light test
5326:Psychiatric history
5259:Medical examination
5048:on 10 February 2009
4844:(3): 244–6, e90–2.
4688:Wilson, MC (2012).
3457:parathyroid hormone
3226:pattern recognition
3224:By clinic-specific
5686:Breast examination
5561:Rectal examination
5495:Respiratory sounds
5294:Nursing assessment
5154:Signs and symptoms
4883:Clinical Chemistry
4573:In popular culture
4157:
4057:
3957:
3877:
3797:
3605:
3453:medical laboratory
3339:
3288:
3034:
3032:
2907:
2905:
2777:
2775:
2647:
2645:
2520:
2518:
2351:
2349:
2294:no disease WHOIFPI
2231:
2178:
2165:no disease WHOIFPI
2134:
2132:
1995:
1993:
1871:
1758:
1680:
1678:
1577:PH → hypercalcemia
1562:
1450:
1061:
959:
879:
877:
753:
655:
653:
479:medical algorithms
148:General components
90:More generally, a
5772:Medical mnemonics
5767:Medical diagnosis
5749:
5748:
5736:Medical diagnosis
5722:
5721:
5597:Elbow examination
5225:
5224:
5220:
5219:
5205:Eponymous disease
5171:Medical diagnosis
5075:(12): 2704–2709.
4889:(12): 2439–2443.
4838:Can Fam Physician
4795:(13): 1214–1219.
4777:at PG Blazer.com.
4674:978-0-89042-575-6
4588:Dr. Gregory House
4512:computer software
4439:parathyroidectomy
4435:
4434:
4394:Correcting factor
4336:Odds(PostH&E)
4227:
4226:
4131:
4130:Correcting factor
4119:
4114:
4095:
4090:
4049:
4036:
4029:
4024:
4006:
4001:
3983:
3982:Correcting factor
3915:
3910:
3830:
3780:
3759:
3738:
3709:
3676:
3549:
3519:
3434:
3433:
3337:
3328:
3323:
3314:
3286:
3283:
3272:
3263:
3234:likelihood ratios
3207:likelihood ratios
3190:
3189:
3013:
2994:
2988:
2972:
2946:
2883:
2864:
2858:
2842:
2816:
2753:
2734:
2728:
2712:
2686:
2626:
2607:
2601:
2585:
2559:
2475:
2458:
2432:
2415:
2390:
2319:
2311:
2295:
2270:
2221:
2213:
2166:
2110:
2083:
2066:
2039:
1963:
1955:
1939:
1914:
1863:
1850:
1828:
1813:
1795:
1756:
1743:
1742:
1730:
1716:
1647:
1639:
1623:
1602:
1554:
1541:
1519:
1483:
1448:
1435:
1434:
1422:
1408:
1296:of, for example,
1251:
1250:
1053:
1038:
1020:
1019:Condition WHOIFPI
952:
944:
928:
927:Condition WHOIFPI
911:
873:
862:
836:
810:
789:
751:
745:
729:
709:
649:
643:
627:
610:
604:
588:
486:medical emergency
252:
251:
244:
226:
142:clinical research
96:diagnostic method
55:In healthcare, a
53:
52:
5779:
5582:Knee examination
5430:Respiratory rate
5369:
5252:
5245:
5238:
5229:
5148:
5130:
5123:
5116:
5107:
5101:
5100:
5064:
5058:
5057:
5055:
5053:
5044:. Archived from
5034:
5028:
5027:
5003:
4997:
4996:
4986:
4962:
4956:
4950:
4944:
4943:
4915:
4909:
4908:
4898:
4874:
4868:
4863:
4853:
4829:
4823:
4820:
4784:
4778:
4764:
4758:
4757:
4737:
4731:
4730:
4710:
4704:
4703:
4685:
4679:
4678:
4660:
4654:
4653:
4651:
4649:
4635:
4402:After correction
4302:Odds(PreH&E)
4277:Other conditions
4264:
4186:Other conditions
4173:
4166:
4164:
4163:
4158:
4132:
4129:
4121:
4120:
4117:
4115:
4112:
4097:
4096:
4093:
4091:
4088:
4066:
4064:
4063:
4058:
4050:
4042:
4037:
4035:
4031:
4030:
4027:
4025:
4022:
4012:
4008:
4007:
4004:
4002:
3999:
3989:
3984:
3981:
3966:
3964:
3963:
3958:
3917:
3916:
3913:
3911:
3908:
3886:
3884:
3883:
3878:
3846:
3845:
3831:
3828:
3806:
3804:
3803:
3798:
3781:
3779:
3765:
3760:
3758:
3748:
3747:
3739:
3736:
3723:
3719:
3718:
3710:
3707:
3694:
3686:
3685:
3677:
3674:
3614:
3612:
3611:
3606:
3559:
3558:
3550:
3547:
3529:
3528:
3520:
3517:
3410:Other conditions
3397:
3348:
3346:
3345:
3340:
3338:
3336:
3329:
3326:
3321:
3320:
3315:
3312:
3297:
3295:
3294:
3289:
3287:
3285:
3284:
3281:
3270:
3269:
3264:
3261:
3061:Other conditions
3050:
3043:
3041:
3040:
3035:
3033:
3014:
3006:
2995:
2993:
2989:
2986:
2977:
2973:
2970:
2961:
2947:
2944:
2933:
2916:
2914:
2913:
2908:
2906:
2884:
2876:
2865:
2863:
2859:
2856:
2847:
2843:
2840:
2831:
2817:
2814:
2803:
2786:
2784:
2783:
2778:
2776:
2754:
2746:
2735:
2733:
2729:
2726:
2717:
2713:
2710:
2701:
2687:
2684:
2673:
2656:
2654:
2653:
2648:
2646:
2627:
2619:
2608:
2606:
2602:
2599:
2590:
2586:
2583:
2574:
2560:
2557:
2546:
2529:
2527:
2526:
2521:
2519:
2476:
2473:
2459:
2456:
2445:
2440:
2433:
2430:
2416:
2413:
2391:
2388:
2377:
2360:
2358:
2357:
2352:
2350:
2322:
2321:
2320:
2317:
2312:
2309:
2296:
2293:
2271:
2268:
2257:
2240:
2238:
2237:
2232:
2224:
2223:
2222:
2219:
2214:
2211:
2187:
2185:
2184:
2179:
2167:
2164:
2143:
2141:
2140:
2135:
2133:
2123:
2118:
2111:
2108:
2096:
2091:
2084:
2081:
2067:
2065:PH in population
2064:
2040:
2037:
2004:
2002:
2001:
1996:
1994:
1966:
1965:
1964:
1961:
1956:
1953:
1940:
1937:
1915:
1912:
1901:
1880:
1878:
1877:
1872:
1864:
1856:
1851:
1843:
1829:
1826:
1815:
1814:
1811:
1796:
1793:
1767:
1765:
1764:
1759:
1757:
1749:
1744:
1740:
1736:
1731:
1728:
1717:
1714:
1689:
1687:
1686:
1681:
1679:
1654:
1650:
1649:
1648:
1645:
1640:
1637:
1624:
1621:
1603:
1600:
1571:
1569:
1568:
1563:
1555:
1547:
1542:
1534:
1520:
1518:PH in population
1517:
1506:
1505:
1484:
1481:
1459:
1457:
1456:
1451:
1449:
1441:
1436:
1432:
1428:
1423:
1420:
1409:
1407:PH in population
1406:
1105:
1070:
1068:
1067:
1062:
1054:
1051:
1040:
1039:
1036:
1021:
1018:
968:
966:
965:
960:
955:
954:
953:
950:
945:
942:
929:
926:
912:
909:
888:
886:
885:
880:
878:
874:
871:
863:
860:
849:
844:
837:
834:
823:
818:
811:
808:
790:
787:
762:
760:
759:
754:
752:
750:
746:
743:
734:
730:
727:
718:
710:
707:
664:
662:
661:
656:
654:
650:
648:
644:
641:
632:
628:
625:
616:
611:
609:
605:
602:
593:
589:
586:
577:
574:
472:Specific methods
465:
455:
446:
436:
426:
417:
408:
398:
388:
379:
370:
360:
351:
342:
332:
322:
313:
303:
247:
240:
236:
233:
227:
225:
184:
160:
152:
130:bipolar disorder
94:is a systematic
46:edit on Wikidata
38:
21:
5787:
5786:
5782:
5781:
5780:
5778:
5777:
5776:
5752:
5751:
5750:
5745:
5718:
5690:
5662:
5641:
5606:
5587:Hip examination
5575:Musculoskeletal
5570:
5542:
5499:
5481:
5448:Eye examination
5434:
5401:
5358:
5279:Chief complaint
5271:Medical history
5265:
5256:
5226:
5221:
5216:
5211:
5207:
5199:
5194:
5190:
5182:
5177:
5173:
5165:
5160:
5156:
5141:
5134:
5104:
5066:
5065:
5061:
5051:
5049:
5036:
5035:
5031:
5005:
5004:
5000:
4964:
4963:
4959:
4951:
4947:
4917:
4916:
4912:
4876:
4875:
4871:
4831:
4830:
4826:
4786:
4785:
4781:
4775:Wayback Machine
4765:
4761:
4754:
4739:
4738:
4734:
4727:
4712:
4711:
4707:
4700:
4687:
4686:
4682:
4675:
4662:
4661:
4657:
4647:
4645:
4637:
4636:
4632:
4628:
4596:
4575:
4562:
4550:
4532:
4508:
4502:
4477:
4468:
4239:medical history
4110:
4086:
4075:
4074:
4020:
4013:
3997:
3990:
3975:
3974:
3906:
3895:
3894:
3826:
3815:
3814:
3769:
3734:
3724:
3705:
3695:
3672:
3661:
3660:
3655:
3636:
3626:
3545:
3515:
3501:
3500:
3486:
3391:
3324:
3306:
3305:
3273:
3255:
3254:
3215:
3202:
3130:
3091:
3031:
3030:
3003:
2997:
2996:
2978:
2962:
2958:
2952:
2951:
2925:
2924:
2904:
2903:
2873:
2867:
2866:
2848:
2832:
2828:
2822:
2821:
2795:
2794:
2774:
2773:
2743:
2737:
2736:
2718:
2702:
2698:
2692:
2691:
2665:
2664:
2644:
2643:
2616:
2610:
2609:
2591:
2575:
2571:
2565:
2564:
2538:
2537:
2517:
2516:
2487:
2481:
2480:
2438:
2437:
2402:
2396:
2395:
2369:
2368:
2348:
2347:
2330:
2324:
2323:
2303:
2282:
2276:
2275:
2249:
2248:
2205:
2200:
2199:
2152:
2151:
2131:
2130:
2116:
2115:
2089:
2088:
2044:
2021:
2020:
1992:
1991:
1974:
1968:
1967:
1947:
1926:
1920:
1919:
1893:
1892:
1887:
1806:
1781:
1780:
1775:
1702:
1701:
1677:
1676:
1652:
1651:
1631:
1607:
1584:
1583:
1578:
1494:
1469:
1468:
1394:
1393:
1338:
1317:medical records
1313:test indication
1264:
1214:
1206:
1198:
1190:
1164:
1156:
1148:
1140:
1086:
1031:
1006:
1005:
997:given by known
987:
936:
897:
896:
876:
875:
842:
841:
816:
815:
794:
771:
770:
735:
719:
695:
694:
652:
651:
633:
617:
594:
578:
566:
565:
535:
526:
474:
461:
451:
442:
432:
422:
413:
404:
394:
384:
375:
366:
356:
347:
338:
328:
318:
309:
299:
258:
248:
237:
231:
228:
185:
183:
173:
165:This paragraph
161:
150:
49:
34:
17:
12:
11:
5:
5785:
5783:
5775:
5774:
5769:
5764:
5754:
5753:
5747:
5746:
5744:
5743:
5738:
5732:
5730:
5724:
5723:
5720:
5719:
5717:
5716:
5711:
5706:
5700:
5698:
5692:
5691:
5689:
5688:
5683:
5678:
5672:
5670:
5664:
5663:
5661:
5660:
5655:
5649:
5647:
5643:
5642:
5640:
5639:
5634:
5629:
5628:
5627:
5616:
5614:
5608:
5607:
5605:
5604:
5599:
5594:
5589:
5584:
5578:
5576:
5572:
5571:
5569:
5568:
5563:
5558:
5552:
5550:
5544:
5543:
5541:
5540:
5539:
5538:
5533:
5525:
5520:
5515:
5509:
5507:
5505:Cardiovascular
5501:
5500:
5498:
5497:
5491:
5489:
5483:
5482:
5480:
5479:
5478:
5477:
5472:
5462:
5461:
5460:
5455:
5453:Ophthalmoscopy
5444:
5442:
5436:
5435:
5433:
5432:
5427:
5425:Blood pressure
5422:
5417:
5411:
5409:
5403:
5402:
5400:
5399:
5394:
5389:
5384:
5378:
5376:
5366:
5360:
5359:
5357:
5356:
5355:
5354:
5351:
5346:
5341:
5333:
5331:Progress notes
5328:
5323:
5321:Social history
5318:
5316:Family history
5313:
5308:
5307:
5306:
5296:
5291:
5289:Systems review
5286:
5281:
5275:
5273:
5267:
5266:
5263:history taking
5257:
5255:
5254:
5247:
5240:
5232:
5223:
5222:
5218:
5217:
5202:
5200:
5185:
5183:
5168:
5166:
5151:
5146:
5143:
5142:
5135:
5133:
5132:
5125:
5118:
5110:
5103:
5102:
5059:
5029:
4998:
4957:
4945:
4926:(3): 410–414.
4910:
4869:
4824:
4779:
4759:
4753:978-0702054044
4752:
4732:
4726:978-1604062199
4725:
4705:
4698:
4680:
4673:
4655:
4629:
4627:
4624:
4623:
4622:
4617:
4612:
4610:Dual diagnosis
4607:
4602:
4595:
4592:
4574:
4571:
4561:
4558:
4549:
4546:
4544:(impression).
4536:Emil Kraepelin
4531:
4528:
4501:
4498:
4476:
4473:
4467:
4464:
4433:
4432:
4429:
4426:
4423:
4420:
4419:P(PostH&E)
4416:
4415:
4412:
4409:
4406:
4403:
4399:
4398:
4395:
4391:
4390:
4387:
4383:
4382:
4379:
4375:
4374:
4371:
4367:
4366:
4363:
4360:
4357:
4354:
4353:P(PostH&E)
4350:
4349:
4346:
4343:
4340:
4337:
4333:
4332:
4329:
4326:
4323:
4320:
4316:
4315:
4312:
4309:
4306:
4303:
4299:
4298:
4295:
4292:
4289:
4286:
4282:
4281:
4278:
4275:
4272:
4267:
4225:
4224:
4221:
4218:
4215:
4212:
4208:
4207:
4204:
4201:
4198:
4195:
4191:
4190:
4187:
4184:
4181:
4176:
4168:
4167:
4156:
4153:
4150:
4147:
4144:
4141:
4138:
4135:
4127:
4124:
4109:
4106:
4103:
4100:
4085:
4082:
4068:
4067:
4056:
4053:
4048:
4045:
4040:
4034:
4019:
4016:
4011:
3996:
3993:
3987:
3968:
3967:
3956:
3953:
3950:
3947:
3944:
3941:
3938:
3935:
3932:
3929:
3926:
3923:
3920:
3905:
3902:
3888:
3887:
3876:
3873:
3870:
3867:
3864:
3861:
3858:
3855:
3852:
3849:
3844:
3841:
3838:
3835:
3825:
3822:
3808:
3807:
3796:
3793:
3790:
3787:
3784:
3778:
3775:
3772:
3768:
3763:
3757:
3754:
3751:
3746:
3743:
3733:
3730:
3727:
3722:
3717:
3714:
3704:
3701:
3698:
3692:
3689:
3684:
3681:
3671:
3668:
3653:
3652:An Odds(PostBT
3650:
3649:
3639:
3634:
3630:
3624:
3616:
3615:
3604:
3601:
3598:
3595:
3592:
3589:
3586:
3583:
3580:
3577:
3574:
3571:
3568:
3565:
3562:
3557:
3554:
3544:
3541:
3538:
3535:
3532:
3527:
3524:
3514:
3511:
3508:
3484:
3432:
3431:
3428:
3425:
3422:
3419:
3415:
3414:
3411:
3408:
3405:
3400:
3390:
3387:
3350:
3349:
3335:
3332:
3318:
3299:
3298:
3279:
3276:
3267:
3230:
3229:
3222:
3214:
3211:
3201:
3198:
3188:
3187:
3184:
3181:
3178:
3175:
3171:
3170:
3163:
3162:
3159:
3156:
3153:
3150:
3144:
3143:
3140:
3137:
3134:
3131:
3128:
3124:
3123:
3120:
3117:
3114:
3111:
3105:
3104:
3101:
3098:
3095:
3092:
3089:
3085:
3084:
3081:
3078:
3075:
3072:
3066:
3065:
3062:
3059:
3056:
3053:
3045:
3044:
3029:
3026:
3023:
3020:
3017:
3012:
3009:
3004:
3002:
2999:
2998:
2992:
2984:
2981:
2976:
2968:
2965:
2959:
2957:
2954:
2953:
2950:
2942:
2939:
2936:
2934:
2932:
2918:
2917:
2902:
2899:
2896:
2893:
2890:
2887:
2882:
2879:
2874:
2872:
2869:
2868:
2862:
2854:
2851:
2846:
2838:
2835:
2829:
2827:
2824:
2823:
2820:
2812:
2809:
2806:
2804:
2802:
2788:
2787:
2772:
2769:
2766:
2763:
2760:
2757:
2752:
2749:
2744:
2742:
2739:
2738:
2732:
2724:
2721:
2716:
2708:
2705:
2699:
2697:
2694:
2693:
2690:
2682:
2679:
2676:
2674:
2672:
2658:
2657:
2642:
2639:
2636:
2633:
2630:
2625:
2622:
2617:
2615:
2612:
2611:
2605:
2597:
2594:
2589:
2581:
2578:
2572:
2570:
2567:
2566:
2563:
2555:
2552:
2549:
2547:
2545:
2531:
2530:
2515:
2512:
2509:
2506:
2503:
2500:
2497:
2494:
2491:
2488:
2486:
2483:
2482:
2479:
2471:
2468:
2465:
2462:
2454:
2451:
2448:
2443:
2441:
2439:
2436:
2428:
2425:
2422:
2419:
2411:
2408:
2405:
2403:
2401:
2398:
2397:
2394:
2386:
2383:
2380:
2378:
2376:
2362:
2361:
2346:
2343:
2340:
2337:
2334:
2331:
2329:
2326:
2325:
2315:
2306:
2302:
2299:
2291:
2288:
2285:
2283:
2281:
2278:
2277:
2274:
2266:
2263:
2260:
2258:
2256:
2242:
2241:
2230:
2227:
2217:
2208:
2189:
2188:
2176:
2173:
2170:
2162:
2159:
2145:
2144:
2129:
2126:
2121:
2119:
2117:
2114:
2106:
2103:
2100:
2094:
2092:
2090:
2087:
2079:
2076:
2073:
2070:
2062:
2059:
2056:
2053:
2050:
2047:
2045:
2043:
2035:
2032:
2029:
2028:
2006:
2005:
1990:
1987:
1984:
1981:
1978:
1975:
1973:
1970:
1969:
1959:
1950:
1946:
1943:
1938:cancer WHOIFPI
1935:
1932:
1929:
1927:
1925:
1922:
1921:
1918:
1910:
1907:
1904:
1902:
1900:
1885:
1882:
1881:
1870:
1867:
1862:
1859:
1854:
1849:
1846:
1841:
1838:
1835:
1832:
1824:
1821:
1818:
1809:
1805:
1802:
1799:
1794:cancer WHOIFPI
1791:
1788:
1773:
1769:
1768:
1755:
1752:
1747:
1739:
1734:
1726:
1723:
1720:
1712:
1709:
1691:
1690:
1675:
1672:
1669:
1666:
1663:
1660:
1657:
1655:
1653:
1643:
1634:
1630:
1627:
1619:
1616:
1613:
1610:
1608:
1606:
1598:
1595:
1592:
1591:
1576:
1573:
1572:
1561:
1558:
1553:
1550:
1545:
1540:
1537:
1532:
1529:
1526:
1523:
1515:
1512:
1509:
1504:
1501:
1497:
1493:
1490:
1487:
1479:
1476:
1461:
1460:
1447:
1444:
1439:
1431:
1426:
1418:
1415:
1412:
1404:
1401:
1370:
1369:
1363:
1360:
1357:
1336:
1321:family history
1263:
1260:
1249:
1248:
1245:
1242:
1239:
1235:
1234:
1230:
1229:
1226:
1223:
1220:
1216:
1215:
1212:
1207:
1204:
1199:
1196:
1191:
1188:
1182:
1181:
1176:
1173:
1170:
1166:
1165:
1162:
1157:
1154:
1149:
1146:
1141:
1138:
1132:
1131:
1128:
1125:
1122:
1118:
1117:
1114:
1111:
1108:
1100:
1099:
1096:
1084:
1079:
1072:
1071:
1060:
1057:
1049:
1046:
1043:
1034:
1030:
1027:
1024:
1016:
1013:
995:relative risks
990:
989:
985:
980:
977:
970:
969:
958:
948:
939:
935:
932:
924:
921:
918:
915:
907:
904:
890:
889:
869:
866:
858:
855:
852:
847:
845:
843:
840:
832:
829:
826:
821:
819:
817:
814:
806:
803:
800:
797:
795:
793:
785:
782:
779:
778:
764:
763:
749:
741:
738:
733:
725:
722:
716:
713:
705:
702:
687:
686:
683:
680:
677:
666:
665:
647:
639:
636:
631:
623:
620:
614:
608:
600:
597:
592:
584:
581:
575:
573:
539:Bayes' theorem
534:
531:
525:
522:
473:
470:
469:
468:
458:
439:
429:
401:
391:
363:
335:
325:
306:
282:
281:
277:
274:
265:
250:
249:
164:
162:
155:
149:
146:
100:disease entity
51:
50:
43:
40:
39:
32:
26:
25:
15:
13:
10:
9:
6:
4:
3:
2:
5784:
5773:
5770:
5768:
5765:
5763:
5760:
5759:
5757:
5742:
5739:
5737:
5734:
5733:
5731:
5729:
5725:
5715:
5712:
5710:
5707:
5705:
5702:
5701:
5699:
5697:
5693:
5687:
5684:
5682:
5679:
5677:
5674:
5673:
5671:
5669:
5668:Gynecological
5665:
5659:
5656:
5654:
5651:
5650:
5648:
5644:
5638:
5635:
5633:
5630:
5626:
5623:
5622:
5621:
5620:Mental status
5618:
5617:
5615:
5613:
5609:
5603:
5600:
5598:
5595:
5593:
5590:
5588:
5585:
5583:
5580:
5579:
5577:
5573:
5567:
5564:
5562:
5559:
5557:
5554:
5553:
5551:
5549:
5545:
5537:
5534:
5532:
5529:
5528:
5526:
5524:
5521:
5519:
5516:
5514:
5511:
5510:
5508:
5506:
5502:
5496:
5493:
5492:
5490:
5488:
5484:
5476:
5473:
5471:
5468:
5467:
5466:
5463:
5459:
5456:
5454:
5451:
5450:
5449:
5446:
5445:
5443:
5441:
5437:
5431:
5428:
5426:
5423:
5421:
5418:
5416:
5413:
5412:
5410:
5408:
5404:
5398:
5395:
5393:
5390:
5388:
5385:
5383:
5380:
5379:
5377:
5375:
5370:
5367:
5365:
5361:
5352:
5350:
5347:
5345:
5342:
5340:
5337:
5336:
5334:
5332:
5329:
5327:
5324:
5322:
5319:
5317:
5314:
5312:
5309:
5305:
5302:
5301:
5300:
5297:
5295:
5292:
5290:
5287:
5285:
5282:
5280:
5277:
5276:
5274:
5272:
5268:
5264:
5260:
5253:
5248:
5246:
5241:
5239:
5234:
5233:
5230:
5215:
5214:
5210:
5206:
5201:
5198:
5197:
5193:
5189:
5184:
5181:
5180:
5176:
5172:
5167:
5164:
5163:
5159:
5155:
5150:
5149:
5144:
5139:
5138:medical terms
5131:
5126:
5124:
5119:
5117:
5112:
5111:
5108:
5098:
5094:
5090:
5086:
5082:
5078:
5074:
5070:
5063:
5060:
5047:
5043:
5039:
5033:
5030:
5025:
5021:
5017:
5013:
5009:
5002:
4999:
4994:
4990:
4985:
4980:
4977:(1): 119–28.
4976:
4972:
4968:
4961:
4958:
4954:
4949:
4946:
4941:
4937:
4933:
4929:
4925:
4921:
4914:
4911:
4906:
4902:
4897:
4892:
4888:
4884:
4880:
4873:
4870:
4867:
4865:
4861:
4857:
4852:
4847:
4843:
4839:
4835:
4828:
4825:
4822:
4818:
4814:
4810:
4806:
4802:
4798:
4794:
4790:
4783:
4780:
4776:
4772:
4769:
4763:
4760:
4755:
4749:
4745:
4744:
4736:
4733:
4728:
4722:
4718:
4717:
4709:
4706:
4701:
4699:9780071804202
4695:
4691:
4684:
4681:
4676:
4670:
4666:
4659:
4656:
4644:
4640:
4634:
4631:
4625:
4621:
4618:
4616:
4613:
4611:
4608:
4606:
4603:
4601:
4598:
4597:
4593:
4591:
4589:
4585:
4584:
4580:
4579:medical drama
4572:
4570:
4567:
4559:
4557:
4555:
4547:
4545:
4543:
4542:
4537:
4529:
4527:
4523:
4519:
4517:
4513:
4507:
4499:
4497:
4495:
4491:
4487:
4481:
4474:
4472:
4465:
4463:
4461:
4456:
4454:
4449:
4447:
4442:
4440:
4430:
4427:
4424:
4421:
4418:
4417:
4413:
4410:
4407:
4404:
4401:
4400:
4393:
4392:
4385:
4384:
4377:
4376:
4369:
4368:
4364:
4361:
4358:
4355:
4352:
4351:
4347:
4344:
4341:
4338:
4335:
4334:
4330:
4327:
4324:
4321:
4318:
4317:
4313:
4310:
4307:
4304:
4301:
4300:
4296:
4293:
4290:
4287:
4285:P(PreH&E)
4284:
4283:
4279:
4276:
4273:
4271:
4268:
4266:
4265:
4262:
4258:
4254:
4252:
4248:
4244:
4240:
4235:
4233:
4222:
4219:
4216:
4213:
4210:
4209:
4205:
4202:
4199:
4196:
4193:
4192:
4188:
4185:
4182:
4180:
4177:
4175:
4174:
4171:
4151:
4148:
4145:
4142:
4136:
4133:
4125:
4101:
4073:
4072:
4071:
4054:
4051:
4046:
4043:
4038:
3985:
3973:
3972:
3971:
3951:
3948:
3942:
3939:
3933:
3930:
3924:
3921:
3893:
3892:
3891:
3871:
3868:
3862:
3859:
3853:
3850:
3842:
3839:
3836:
3833:
3813:
3812:
3811:
3791:
3788:
3785:
3782:
3776:
3773:
3770:
3766:
3761:
3755:
3752:
3744:
3741:
3728:
3725:
3715:
3712:
3699:
3696:
3690:
3682:
3679:
3659:
3658:
3657:
3647:
3643:
3640:
3637:
3631:
3628:
3621:
3620:
3619:
3602:
3599:
3596:
3593:
3590:
3587:
3584:
3578:
3575:
3569:
3566:
3563:
3555:
3552:
3539:
3536:
3533:
3525:
3522:
3509:
3506:
3499:
3498:
3497:
3495:
3491:
3487:
3479:
3477:
3473:
3469:
3464:
3460:
3458:
3454:
3449:
3447:
3443:
3438:
3429:
3426:
3423:
3420:
3417:
3416:
3412:
3409:
3406:
3404:
3401:
3399:
3398:
3395:
3388:
3386:
3384:
3380:
3376:
3372:
3367:
3363:
3362:medical tests
3359:
3354:
3333:
3330:
3316:
3304:
3303:
3302:
3277:
3274:
3265:
3253:
3252:
3251:
3249:
3248:
3247:odds in favor
3243:
3242:probabilities
3239:
3235:
3227:
3223:
3220:
3219:
3218:
3212:
3210:
3208:
3199:
3197:
3194:
3185:
3182:
3179:
3176:
3173:
3172:
3168:
3164:
3160:
3157:
3154:
3151:
3149:
3146:
3145:
3141:
3138:
3135:
3132:
3126:
3125:
3121:
3118:
3115:
3112:
3110:
3107:
3106:
3102:
3099:
3096:
3093:
3087:
3086:
3082:
3079:
3076:
3073:
3071:
3068:
3067:
3063:
3060:
3057:
3054:
3052:
3051:
3048:
3024:
3021:
3018:
3015:
3010:
3007:
3000:
2955:
2935:
2923:
2922:
2921:
2900:
2894:
2891:
2888:
2885:
2880:
2877:
2870:
2825:
2805:
2793:
2792:
2791:
2770:
2764:
2761:
2758:
2755:
2750:
2747:
2740:
2695:
2675:
2663:
2662:
2661:
2637:
2634:
2631:
2628:
2623:
2620:
2613:
2568:
2548:
2536:
2535:
2534:
2513:
2510:
2507:
2504:
2501:
2498:
2495:
2492:
2489:
2484:
2463:
2446:
2442:
2420:
2404:
2399:
2379:
2367:
2366:
2365:
2344:
2341:
2338:
2335:
2332:
2327:
2318:hypercalcemia
2304:
2300:
2284:
2279:
2259:
2247:
2246:
2245:
2228:
2225:
2220:hypercalcemia
2206:
2198:
2197:
2196:
2194:
2174:
2171:
2150:
2149:
2148:
2127:
2124:
2120:
2098:
2093:
2071:
2054:
2051:
2048:
2046:
2019:
2018:
2017:
2015:
2010:
1988:
1985:
1982:
1979:
1976:
1971:
1962:hypercalcemia
1948:
1944:
1928:
1923:
1903:
1891:
1890:
1889:
1868:
1865:
1860:
1857:
1852:
1847:
1844:
1839:
1836:
1833:
1816:
1807:
1803:
1800:
1779:
1778:
1777:
1753:
1750:
1745:
1737:
1732:
1724:
1721:
1700:
1699:
1698:
1696:
1673:
1670:
1667:
1664:
1661:
1658:
1656:
1646:hypercalcemia
1632:
1628:
1611:
1609:
1582:
1581:
1580:
1559:
1556:
1551:
1548:
1543:
1538:
1535:
1530:
1527:
1524:
1507:
1502:
1499:
1495:
1491:
1488:
1467:
1466:
1465:
1445:
1442:
1437:
1433:4000 per year
1429:
1424:
1416:
1413:
1392:
1391:
1390:
1387:
1383:
1377:
1375:
1374:P(PH WHOIFPI)
1368:
1364:
1361:
1358:
1356:
1353:
1352:
1351:
1349:
1345:
1340:
1334:
1333:relative risk
1330:
1326:
1322:
1318:
1314:
1309:
1307:
1306:hypercalcemia
1303:
1299:
1298:serum calcium
1295:
1290:
1288:
1287:
1283:
1279:
1275:
1270:
1261:
1259:
1257:
1246:
1243:
1240:
1237:
1236:
1231:
1227:
1224:
1221:
1218:
1217:
1211:
1208:
1203:
1200:
1195:
1192:
1187:
1184:
1183:
1180:
1177:
1174:
1171:
1168:
1167:
1161:
1158:
1153:
1150:
1145:
1142:
1137:
1134:
1133:
1129:
1126:
1123:
1120:
1119:
1115:
1112:
1109:
1107:
1106:
1103:
1097:
1094:
1090:
1089:relative risk
1083:
1080:
1077:
1076:
1075:
1058:
1041:
1032:
1028:
1025:
1004:
1003:
1002:
1000:
996:
984:
981:
978:
975:
974:
973:
956:
937:
933:
916:
895:
894:
893:
867:
850:
846:
824:
820:
798:
796:
769:
768:
767:
714:
693:
692:
691:
684:
681:
678:
675:
671:
670:
669:
612:
564:
563:
562:
560:
556:
552:
548:
544:
540:
532:
530:
523:
521:
518:
516:
510:
508:
507:
506:
500:
499:
498:pathognomonic
493:
491:
487:
482:
480:
471:
467:
464:
459:
457:
454:
448:
445:
440:
438:
435:
430:
428:
425:
419:
416:
410:
407:
402:
400:
397:
392:
390:
387:
381:
378:
372:
369:
364:
362:
359:
353:
350:
344:
341:
336:
334:
331:
326:
324:
321:
315:
312:
307:
305:
302:
297:
296:
295:
293:
292:
287:
278:
275:
272:
271:
266:
263:
262:
261:
257:
246:
243:
235:
224:
221:
217:
214:
210:
207:
203:
200:
196:
193: –
192:
188:
187:Find sources:
181:
177:
171:
170:
163:
159:
154:
153:
147:
145:
143:
137:
135:
131:
127:
123:
118:
116:
111:
109:
105:
101:
97:
93:
88:
86:
82:
78:
74:
70:
66:
62:
58:
47:
37:
33:
31:
27:
22:
19:
5740:
5612:Neurological
5566:Bowel sounds
5523:Heart sounds
5387:Auscultation
5203:
5186:
5174:
5169:
5152:
5072:
5068:
5062:
5050:. Retrieved
5046:the original
5041:
5032:
5015:
5011:
5001:
4974:
4970:
4960:
4948:
4923:
4919:
4913:
4886:
4882:
4872:
4841:
4837:
4827:
4792:
4788:
4782:
4762:
4742:
4735:
4715:
4708:
4689:
4683:
4664:
4658:
4646:. Retrieved
4642:
4633:
4582:
4576:
4563:
4553:
4551:
4539:
4533:
4524:
4520:
4509:
4482:
4478:
4475:Combinations
4469:
4460:Combinations
4459:
4457:
4450:
4443:
4436:
4259:
4255:
4245:, where the
4236:
4228:
4169:
4069:
3969:
3889:
3809:
3651:
3641:
3632:
3622:
3617:
3489:
3482:
3480:
3465:
3461:
3450:
3439:
3435:
3392:
3365:
3360:for further
3355:
3351:
3300:
3245:
3231:
3216:
3203:
3195:
3191:
3166:
3147:
3108:
3069:
3046:
2919:
2789:
2659:
2532:
2363:
2243:
2190:
2146:
2013:
2011:
2007:
1888:= 0.1), so:
1883:
1770:
1741:250 per year
1694:
1692:
1574:
1462:
1386:time-at-risk
1378:
1373:
1371:
1354:
1341:
1310:
1291:
1285:
1281:
1277:
1273:
1272:
1265:
1255:
1252:
1209:
1201:
1193:
1185:
1178:
1159:
1151:
1143:
1135:
1101:
1093:risk factors
1081:
1073:
991:
982:
971:
951:presentation
891:
765:
688:
673:
667:
558:
554:
550:
546:
536:
527:
519:
511:
505:sine qua non
503:
502:
496:
494:
490:ABC protocol
483:
475:
462:
456:nvironmental
452:
443:
433:
423:
414:
405:
395:
385:
376:
367:
357:
348:
339:
329:
319:
310:
300:
290:
289:
283:
269:
268:
259:
238:
232:October 2011
229:
219:
212:
205:
198:
186:
174:Please help
169:verification
166:
138:
119:
112:
91:
89:
60:
56:
54:
18:
5653:Apgar score
5602:GALS screen
5487:Respiratory
5415:Temperature
5407:Vital signs
5304:Medications
4648:30 December
4600:Comorbidity
4566:taxonomists
4280:No disease
4189:No disease
3623:Odds(PostBT
3472:specificity
3468:sensitivity
3418:Probability
3413:No disease
3379:sensitivity
3371:specificity
3358:indications
3313:probability
3282:probability
3271:probability
3064:No disease
1729: years
1421: years
1329:risk factor
999:risk factor
515:indications
380:ntoxication
343:egenerative
314:nflammatory
85:common cold
5756:Categories
5556:Liver span
5420:Heart rate
5397:Percussion
5382:Inspection
5335:Mnemonics
5018:: 205–10.
4626:References
3633:Odds(PreBT
3446:indication
3169:= 0.00335
2310:no disease
2212:no disease
2014:no disease
1622:PH WHOIFPI
1482:PH WHOIFPI
1294:blood test
291:VINDICATEM
202:newspapers
126:psychology
122:psychiatry
81:bronchitis
69:clinicians
5548:Abdominal
5392:Palpation
5299:Allergies
5213:Remission
5179:Prognosis
5052:3 October
4211:P(PostBT)
4155:%
4143:⋅
4140:%
4126:⋅
3955:%
3946:%
3937:%
3928:%
3875:%
3866:%
3860:−
3857:%
3795:%
3729:
3700:
3591:⋅
3564:⋅
3540:
3510:
3278:−
3028:%
2898:%
2768:%
2641:%
2342:≈
2336:⋅
2314:→
2301:⋅
2216:→
2099:−
2072:−
2055:−
1980:⋅
1958:→
1945:⋅
1840:⋅
1817:⋅
1801:≈
1733:⋅
1665:⋅
1642:→
1629:⋅
1531:⋅
1508:⋅
1489:≈
1425:⋅
1346:(PH) and
1335:of 10 (RR
1274:very high
1139:condition
1085:condition
1042:⋅
1037:condition
1026:≈
947:→
943:condition
934:⋅
674:condition
409:utoimmune
399:ongenital
389:atrogenic
371:diopathic
352:eficiency
333:eoplastic
323:nfectious
108:epistemic
5681:Pap test
5646:Neonatal
5372:General/
5353:COASTMAP
5158:Syndrome
5097:53758271
5089:30475443
5024:16160260
4993:16400472
4940:21723154
4860:20228307
4809:10199432
4771:Archived
4594:See also
4494:staining
4194:P(PreBT)
3366:endpoint
3074:0.000125
1286:very low
1269:decimals
466:etabolic
447:ndocrine
437:raumatic
286:mnemonic
73:diagnose
5465:Hearing
5192:Chronic
5162:Disease
5042:nih.gov
4905:3058363
4851:2837688
4817:2389981
4541:gestalt
4530:History
3644:is the
3618:where:
3389:Example
3161:0.0014
3152:0.00125
3142:0.0014
3113:0.00125
3011:0.00335
2881:0.00335
2751:0.00335
2624:0.00335
2621:0.00125
2514:0.00335
2490:0.00125
1989:0.0002.
1674:0.00125
1662:0.00125
1560:0.00125
1384:), the
1339:= 10).
1262:Example
1087:is the
1074:where:
972:where:
668:where:
427:natomic
418:llergic
304:ascular
280:Guess."
216:scholar
77:patient
65:disease
36:D003937
5696:Sports
5527:Other
5344:OPQRST
5339:SAMPLE
5136:Basic
5095:
5087:
5022:
4991:
4938:
4903:
4858:
4848:
4815:
4807:
4750:
4723:
4696:
4671:
4373:98.9%
4342:0.0285
4314:0.148
4297:12.9%
4274:Cancer
4223:12.9%
4206:41.8%
4183:Cancer
4118:cancer
4094:cancer
4089:PostBT
4000:PostBT
3829:PostBT
3737:PostBT
3708:PostBT
3675:PostBT
3642:LH(BT)
3518:PostBT
3483:Pre-BT
3430:41.8%
3407:Cancer
3213:Theory
3186:41.8%
3158:0.0005
3155:0.0002
3083:0.997
3058:Cancer
3008:0.0014
2878:0.0005
2748:0.0002
2508:0.0014
2502:0.0005
2496:0.0002
2345:0.0014
2339:0.0014
2229:0.0014
2175:0.997.
2128:0.997.
1954:cancer
1869:0.002.
1812:cancer
1776:= 1):
1774:cancer
1695:cancer
1359:Cancer
1348:cancer
551:WHOIFP
533:Theory
218:
211:
204:
197:
189:
5714:RED-S
5475:Rinne
5470:Weber
5440:HEENT
5188:Acute
5093:S2CID
4813:S2CID
4583:House
4431:0.8%
4422:96.1%
4414:0.8%
4381:1.1%
4356:96.1%
4311:0.048
4308:0.019
4288:80.6%
4232:visit
4214:80.6%
4203:14.9%
4197:37.3%
4146:0.309
4113:PreBT
4055:0.309
4023:PreBT
3909:PreBT
3786:0.806
3588:0.595
3548:PreBT
3494:post-
3427:14.9%
3421:37.3%
3183:14.9%
3177:37.3%
3116:0.002
3077:0.002
3019:0.418
2889:0.149
2759:0.060
2632:0.373
2333:0.997
1977:0.002
223:JSTOR
209:books
44:[
5374:IPPA
5349:SOAP
5261:and
5196:Cure
5085:PMID
5054:2008
5020:PMID
4989:PMID
4936:PMID
4901:PMID
4856:PMID
4805:PMID
4789:JAMA
4766:Cf.
4748:ISBN
4721:ISBN
4694:ISBN
4669:ISBN
4650:2014
4428:0.3%
4425:2.8%
4411:0.3%
4359:2.8%
4339:24.9
4305:4.15
4294:4.6%
4291:1.9%
4220:4.6%
4217:1.9%
4200:6.0%
4047:62.7
4044:19.4
4028:rest
4005:rest
3952:62.7
3943:41.8
3934:14.9
3914:rest
3872:19.4
3863:80.6
3792:80.6
3771:4.16
3767:4.16
3726:Odds
3697:Odds
3600:4.16
3537:Odds
3507:Odds
3490:prae
3424:6.0%
3327:odds
3322:odds
3262:odds
3180:6.0%
3025:41.8
2895:14.9
2638:37.3
1693:For
1539:8000
1446:8000
1278:high
872:etc.
361:rugs
195:news
30:MeSH
5077:doi
5073:176
5016:116
4979:doi
4928:doi
4924:213
4891:doi
4846:PMC
4797:doi
4793:281
4325:1.5
4152:1.9
4137:6.0
3925:6.0
3854:100
3244:to
3136:0.1
2765:6.0
1983:0.1
1861:500
1848:500
1772:(RR
1754:500
1725:0.5
1552:800
1417:0.5
1323:of
1284:or
1282:low
559:has
555:has
543:die
481:).
178:by
87:).
71:to
61:DDx
5758::
5091:.
5083:.
5071:.
5040:.
5014:.
5010:.
4987:.
4975:39
4973:.
4969:.
4934:.
4922:.
4899:.
4887:34
4885:.
4881:.
4854:.
4842:56
4840:.
4836:.
4811:.
4803:.
4791:.
4641:.
4365:-
4348:-
4331:-
4270:PH
4179:PH
4105:Pr
4081:Pr
4015:Pr
3992:Pr
3901:Pr
3821:Pr
3667:Pr
3654:PH
3635:PH
3625:PH
3485:PH
3403:PH
3122:-
3103:-
3094:10
3088:RR
3055:PH
2980:Pr
2964:Pr
2938:Pr
2850:Pr
2834:Pr
2808:Pr
2720:Pr
2704:Pr
2678:Pr
2593:Pr
2577:Pr
2551:Pr
2467:Pr
2450:Pr
2424:Pr
2407:Pr
2382:Pr
2287:Pr
2262:Pr
2158:Pr
2102:Pr
2075:Pr
2058:Pr
2031:Pr
1931:Pr
1906:Pr
1820:Pr
1787:Pr
1708:Pr
1638:PH
1615:Pr
1594:Pr
1528:10
1511:Pr
1475:Pr
1400:Pr
1337:PH
1280:,
1276:,
1160:RR
1152:RR
1144:RR
1136:RR
1082:RR
1045:Pr
1012:Pr
920:Pr
903:Pr
854:Pr
828:Pr
802:Pr
781:Pr
737:Pr
721:Pr
701:Pr
635:Pr
619:Pr
596:Pr
580:Pr
449:/
420:/
411:/
382:/
373:/
354:/
345:/
316:/
294::
284:A
144:.
5251:e
5244:t
5237:v
5129:e
5122:t
5115:v
5099:.
5079::
5056:.
5026:.
4995:.
4981::
4942:.
4930::
4907:.
4893::
4862:.
4819:.
4799::
4756:.
4729:.
4702:.
4677:.
4652:.
4408:-
4405:-
4362:-
4345:-
4328:-
4322:6
4149:=
4134:=
4123:)
4108:(
4102:=
4099:)
4084:(
4052:=
4039:=
4033:)
4018:(
4010:)
3995:(
3986:=
3949:=
3940:+
3931:+
3922:=
3919:)
3904:(
3869:=
3851:=
3848:)
3843:t
3840:s
3837:e
3834:r
3824:(
3789:=
3783:=
3777:1
3774:+
3762:=
3756:1
3753:+
3750:)
3745:H
3742:P
3732:(
3721:)
3716:H
3713:P
3703:(
3691:=
3688:)
3683:H
3680:P
3670:(
3627:)
3603:,
3597:=
3594:7
3585:=
3582:)
3579:T
3576:B
3573:(
3570:H
3567:L
3561:)
3556:H
3553:P
3543:(
3534:=
3531:)
3526:H
3523:P
3513:(
3334:1
3331:+
3317:=
3275:1
3266:=
3139:-
3133:1
3127:r
3119:-
3100:-
3097:1
3090:x
3080:-
3022:=
3016:=
3001:=
2991:)
2983:(
2975:)
2967:(
2956:=
2949:)
2941:(
2901:,
2892:=
2886:=
2871:=
2861:)
2853:(
2845:)
2837:(
2826:=
2819:)
2811:(
2771:,
2762:=
2756:=
2741:=
2731:)
2723:(
2715:)
2707:(
2696:=
2689:)
2681:(
2635:=
2629:=
2614:=
2604:)
2596:(
2588:)
2580:(
2569:=
2562:)
2554:(
2511:=
2505:+
2499:+
2493:+
2485:=
2478:)
2470:(
2464:+
2461:)
2453:(
2447:+
2435:)
2427:(
2421:+
2418:)
2410:(
2400:=
2393:)
2385:(
2328:=
2305:r
2298:)
2290:(
2280:=
2273:)
2265:(
2226:=
2207:r
2172:=
2169:)
2161:(
2125:=
2113:)
2105:(
2086:)
2078:(
2069:)
2061:(
2052:1
2049:=
2042:)
2034:(
1986:=
1972:=
1949:r
1942:)
1934:(
1924:=
1917:)
1909:(
1866:=
1858:1
1853:=
1845:1
1837:1
1834:=
1831:)
1823:(
1808:R
1804:R
1798:)
1790:(
1751:1
1746:=
1738:1
1722:=
1719:)
1711:(
1671:=
1668:1
1659:=
1633:r
1626:)
1618:(
1612:=
1605:)
1597:(
1557:=
1549:1
1544:=
1536:1
1525:=
1522:)
1514:(
1503:H
1500:P
1496:R
1492:R
1486:)
1478:(
1443:1
1438:=
1430:1
1414:=
1411:)
1403:(
1254:(
1210:r
1202:r
1194:r
1186:r
1163:3
1155:2
1147:1
1059:,
1056:)
1048:(
1033:R
1029:R
1023:)
1015:(
983:r
957:,
938:r
931:)
923:(
917:=
914:)
906:(
868:+
865:)
857:(
851:+
839:)
831:(
825:+
813:)
805:(
799:=
792:)
784:(
748:)
740:(
732:)
724:(
715:=
712:)
704:(
646:)
638:(
630:)
622:(
613:=
607:)
599:(
591:)
583:(
463:M
453:E
444:E
434:T
424:A
415:A
406:A
396:C
386:I
377:I
368:I
358:D
349:D
340:D
330:N
320:I
311:I
301:V
245:)
239:(
234:)
230:(
220:·
213:·
206:·
199:·
172:.
124:/
59:(
48:]
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