Re: [心得] 關於r/o

看板medstudent (醫學生)作者SiFong (俠之大者)時間18年前 (2006/07/17 10:47)推噓1(1推 0噓 4→)

留言5則, 1人參與討論串3/3 (看更多)

剛剛用google查了一下 rule out的定義: (diagnosis term) A working diagnosis. Your healthcare provider thinks this is the most likely diagnosis, and will either confirm or discard it (rule it out), based on the results of further tests or investigations. A working diagnosis is a diagnosis that is known to be uncertain, but which is used to define a course of action. Note that the working diagnosis is not necessarily the most likely item in the differential. 舉例而言:(一個國外blog: http://trots.blogspot.com/) 在2005/2/23的文章有寫到關於differential diagnosis "一個病人來急診抱怨胸痛" 當時的DD可能是:pneumonia, heart attack, pulmonary embolism.....等等經過interview,PE...(對不起,我省略很多) 醫生覺得pneumonia最有可能但又排除不掉Pulmonary embolism 可能會排個lung scan... 此時working diagnosis就是"R/O PE"(即使pneumonia是心裡第一順位) (當然若是能寫更詳細是更好) 若是結果是equivocal的或是low probility... 此時的診斷變成"pneumonia, R/O PE" PE還是有可能,不過順位就沒有那麼前面了 Rule out帶有著點negative finding的意涵.... ---------------------------------------------------------------------- 比較明確的結論是:R/O A病可用於住院時的診斷。不過住院診斷工作 (work up) 之後，許多診斷應該是已經被ruled in 或ruled out。如診斷仍未被確認，而A病還是最有可能則寫成Discharge diagnosis: probable A病或suspected A病較為適當。感覺rule out~~要滿小心的寫 P.S.: 1.野人獻曝,整理的有點亂....:) 2.不過關於報case時要怎麼用...還是不太明白 Tentative diagnosis要放在那一張好呢?? 畢竟每個r/o,感覺後面要有對應的work-up Sorry...當完兵..都忘了 -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 218.175.154.212 ※ 編輯: SiFong 來自: 218.175.154.212 (07/17 11:51)