Patient complaining of cough in primary care

Vrach Pub Date : 2024-02-02 DOI:10.29296/25877305-2024-02-06
E. Borodulina, L. Katina, E. Yakovleva
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Abstract

Cough is one of the most common symptoms when seeking primary medical care. Purpose. To increase the efficiency of diagnostic search for the cause of cough in the practice of a primary care doctor. Materials and methods. A comparative analysis of 2 different approaches to the tactics of primary admission of patients who complained of cough was carried out (n=1800): group 1 is the traditional approach in the work of a primary care physician; group 2 is the application before admission of the "Diagnostic search algorithm in the examination of a patient with cough complaints", developed on the basis of the generated database. Results. In the group 42,3% of patients were initially diagnosed with acute respiratory viral infection (ARVI), and 13,2% suspected pneumonia. Cough due to other causes was 44,5%. In the group 2, ARVI was diagnosed in 19% of cases, an exacerbation of COPD was detected in 11,8%, bronchial asthma in 8,9%, in 6,7% congestive heart failure, in 6,1% gastroesophageal reflux disease, in 2,1% focal pulmonary tuberculosis, in 23% pneumonia, in 6,7% COVID-19, in 15,7% chronic sinusitis. Conclusion. The use of the algorithm in the practice of a general practitioner to identify the cause of cough can significantly facilitate the diagnostic search and reduce the number of unjustified consultations of specialist doctors. Also, this approach in the world of digitalization allows us to develop an intelligent service to support medical decision-making.
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初级保健中的咳嗽患者
咳嗽是寻求初级医疗服务时最常见的症状之一。目的是提高初级保健医生诊断咳嗽病因的效率。材料和方法。对初级入院治疗咳嗽患者的两种不同方法进行了比较分析(n=1800):第 1 组是初级保健医生工作中的传统方法;第 2 组是在入院前应用 "咳嗽主诉患者检查诊断搜索算法",该算法是在生成的数据库基础上开发的。结果显示该组中有 42.3% 的患者被初步诊断为急性呼吸道病毒感染 (ARVI),13.2% 的患者被怀疑为肺炎。其他原因引起的咳嗽占 44.5%。在第 2 组中,19% 的病例被诊断为急性呼吸道病毒感染,11.8% 的病例被诊断为慢性阻塞性肺病加重,8.9% 的病例被诊断为支气管哮喘,6.7% 的病例被诊断为充血性心力衰竭,6.1% 的病例被诊断为胃食管反流病,2.1% 的病例被诊断为局灶性肺结核,23% 的病例被诊断为肺炎,6.7% 的病例被诊断为 COVID-19,15.7% 的病例被诊断为慢性鼻窦炎。最后得出结论。在全科医生的临床实践中使用该算法来确定咳嗽的病因,可以大大方便诊断搜索,减少专科医生不合理会诊的次数。此外,在数字化的世界里,这种方法还能让我们开发出支持医疗决策的智能服务。
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