Developing and Updating Differential Diagnosis Tables in Emergency Medicine for Potentially Life-Threatening Diseases

Abstract

Background: No study has verified whether the published differential diagnosis tables cover all potentially life-threatening diseases observed in real-world clinical practice and updated the tables using real-world data.

Objectives: To create initial differential diagnosis tables based on published resources, and to validate and update the tables using the National Hospital and Ambulatory Medical Care Survey (NHAMCS) database as a real-world reference METHODS: We created the initial differential diagnosis tables using published textbooks, UpToDate®, BMJ Best Practice, and databases (Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar databases) without language restrictions from their inception to September 22, 2022. Then, we extracted chief complaints and diagnosis lists from the NHAMCS database of emergency patients aged ≥16 years between November 2016 and 2019. Finally, we compared the diagnosis lists from the NAMCS database and the initial tables to cover all potentially life-threatening diseases.

Results: We created the initial tables for 78 chief complaints and 2054 differential diagnoses (554 and 1500 in the red and yellow categories, respectively). Additionally, we created 71 chief complaints and 1,468 differential diagnoses from the NHAMCS database. We found 114 potentially life-threatening diseases associated with 39 chief complaints not covered by the initial tables. Finally, the initial tables were updated to include 78 chief complaints and 2168 differential diagnoses.

Conclusions: The updated differential diagnosis tables will help prevent missed diagnoses of potentially life-threatening diseases, improve patient outcomes, and facilitate clinical research.

Keywords: Chief complaint; Differential diagnosis; Emergency care; Life-threatening disease; National hospital and ambulatory medical care survey (NHAMCS).