Final diagnoses and probability of new reason-for-encounter at an urban clinic in Japan: A 4-year observational study

Past clinical data are not currently used to calculate pretest probabilities, as they have not been put into a database in clinical settings. This observational study was designed to determine the initial reasons for utilizing home visits or visits to an outpatient urban clinic in Japan. All family medical clinic outpatients and patients visited by the clinic (total = 11,688) over 1460 days were enrolled. We used a Bayes theorem-based clinical decision support system to analyze codes for initial reason-for-encounter (examination and final diagnosis: pretest probability) and final diagnosis of patients with fever (conditional pretest probability). Total number of reasons-for-encounter: 96,653 (an average of 1.2 reasons per visit). Final diagnosis: 62,273 cases (an average of 0.75 cases per visit). The most common reasons for initial examination were immunizations, physical examinations, and upper respiratory conditions. Regarding the final diagnosis, the combination of physical examinations and acute upper respiratory infections comprised 73.4% of cases. In cases where fever developed, the bulk of the final diagnoses were infectious diseases such as influenza, strep throat, and gastroenteritis of presumed infectious origin. For the elderly, fever often occurred with other health issues such as pneumonia, dementia, constipation, and sleep disturbances, though the cause of the fever remained undetermined in 40% of the cases. The pretest probability changed significantly based on the reason or the combination of reasons for which patients requested a medical examination. Using accumulated data from past diagnoses to modify subsequent subjective diagnoses, individual diagnoses can be improved.