Vital signs, clinical rules, and gut feeling: an observational study among patients with fever

Latten, Gideon; Claassen, Lieke; Coumans, Lucinda; Goedemondt, Vera; Brouwer, Calvin; Muris, Jean; Cals, Jochen; Stassen, Patricia M.

doi:10.3399/bjgpo.2021.0125

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…Repeated observational and qualitative studies have shown that the GFQ can be effectively used to assess the role of ‘gut feelings’ in GPs’ decision-making process in uncertain situations [ 10 , 11 , 15 ]. It has been shown that the sense of alarm correlated with a life-threatening situation for patients presenting with dyspnoea and/or chest pain [ 10 ], in line with other studies showing that GPs’ ‘gut feelings’ might predict clinical severe problems [ 16–18 ].…”

Section: Discussionmentioning

confidence: 99%

The linguistic validation of the gut feelings questionnaire in Turkish

Elbi,

Tan,

Yokus

et al. 2023

European Journal of General Practice

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Background ‘Gut feelings’ are frequently used by general practitioners in the clinical decision-making process, especially in situations of uncertainty. The Gut Feelings Questionnaire (GFQ) has been developed in the Netherlands and is now available in English, French, German, Polish, Spanish, and Catalan, enabling cross-border studies on the subject. However, a Turkish version of the GFQ is lacking. Objectives A Turkish version of the GFQ. Methods A linguistic validation procedure was conducted, which took place in six phases: forward translation (step 1), backward translation (step 2), first consensus (step 3), cultural validation (step 4), second consensus (step 5), and final version (step 6). Results The absence of literal equivalent of the term ‘gut feelings’ in Turkish was determined. The word ‘intuition’ was chosen as the Turkish literal equivalent of ‘gut feelings’. There were also some challenges in finding the exact meanings of words and expressions in Turkish literature. However, we succeeded in finding adequate and responsible solutions. A Turkish version of the GFQ is available now. Conclusion With these validated GFQs, Turkish GPs can facilitate studies of the role of ‘gut feelings’ in clinical reasoning.

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Section: Discussionmentioning

confidence: 99%

The linguistic validation of the gut feelings questionnaire in Turkish

Elbi,

Tan,

Yokus

et al. 2023

European Journal of General Practice

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“…Clinical intuition is a non-analytic, subconscious and instinctive process, through which physicians assess the severity of the patient's illness [8][9][10][11]. The ED physician's clinical intuition has demonstrated commendable discriminatory performance in previous studies, predicting adverse outcomes in ED patients (i.e.…”

Section: Introductionmentioning

confidence: 99%

Acute internal medicine physicians’ clinical intuition based on acute care telephone referral: A prospective study

van Dam,

Lasso Peña,

Mommertz

et al. 2024

PLoS ONE

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Introduction In the Netherlands, most emergency department (ED) patients are referred by a general practitioner (GP) or a hospital specialist. Early risk stratification during telephone referral could allow the physician to assess the severity of the patients’ illness in the prehospital setting. We aim to assess the discriminatory value of the acute internal medicine (AIM) physicians’ clinical intuition based on telephone referral of ED patients to predict short-term adverse outcomes, and to investigate on which information their predictions are based. Methods In this prospective study, we included adult ED patients who were referred for internal medicine by a GP or a hospital specialist. Primary outcomes were hospital admission and triage category according to the Manchester Triage System (MTS). Secondary outcome was 31-day mortality. The discriminatory performance of the clinical intuition was assessed using an area under the receiver operating characteristics curve (AUC). To identify which information is important to predict adverse outcomes, we performed univariate regression analysis. Agreement between predicted and observed MTS triage category was assessed using intraclass and Spearman’s correlation. Results We included 333 patients, of whom 172 (51.7%) were referred by a GP, 146 (43.8%) by a hospital specialist, and 12 (3.6%) by another health professional. The AIM physician’s clinical intuition showed good discriminatory performance regarding hospital admission (AUC 0.72, 95% CI: 0.66–0.78) and 31-day mortality (AUC 0.73, 95% CI: 0.64–0.81). Univariate regression analysis showed that age ≥65 years and a sense of alarm were significant predictors. The predicted and observed triage category were similar in 45.2%, but in 92.5% the prediction did not deviate by more than one category. Intraclass and Spearman’s correlation showed fair agreement between predicted and observed triage category (ICC 0.48, Spearman’s 0.29). Conclusion Clinical intuition based on relevant information during a telephone referral can be used to accurately predict short-term outcomes, allowing for early risk stratification in the prehospital setting and managing ED patient flow more effectively.

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A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality

García-Marichal,

Aguilar-Jerez,

Delgado-Plasencia

et al. 2024

J GEN INTERN MED

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Background Most patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality. Objective The aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality. Design Retrospective cohort study. Patients We included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history. Main Measures Primary outcome was to assess risk of admission or mortality. Key Results 278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82–142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19–34.48), obesity (RR: 1.53 (1.12–2.10), chronic kidney disease (RR:2.31 (1.23–4.35), ≥ 60 years of age (RR: 1.44 (1.04–1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15–55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62–10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70–15.15), chronic respiratory disease (RR: 3.32 (1.43–7.69) and active malignancy (RR: 4.00 (1.42–11.23). Conclusions Vulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.

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Vital signs, clinical rules, and gut feeling: an observational study among patients with fever

Cited by 3 publications

References 17 publications

The linguistic validation of the gut feelings questionnaire in Turkish

The linguistic validation of the gut feelings questionnaire in Turkish

Acute internal medicine physicians’ clinical intuition based on acute care telephone referral: A prospective study

A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality

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