Differential diagnosis of jaundice: a pocket diagnostic chart

Abstract

ABSTRACT— Based on extensive clinical and clinical chemical information (107 different items) from 1002 jaundiced patients, we developed a diagnostic algorithm which was evaluated on a test sample of another 110 jaundiced patients. A primary classification into categories of obstructive jaundice (probability of obstruction ≥0.80), non‐obstructive jaundice (probability of obstruction ≤0.20), and of doubtful causes of jaundice (probability of obstruction: 0.20–0.80) was attempted. Among 234 patients in the data base who were classified as obstructive, 220 (94%) proved to be so, as did 36 (97%) of 37 in the test sample. The corresponding figures for non‐obstructive jaundice were 463 (96%) of 483 patients correctly classified in the data base and 47 (92%) of 51 patients in the test sample. Altogether 69% of the patients in the data base and 75% of those in the test sample were correctly classified, in 27% and 20% the cause of jaundice was doubtful, and only 4% and 5%, respectively, were misclassified. A slight majority of the patients in whom the algorithmic diagnoses were doubtful proved obstructive. A close correlation was found between the preliminary diagnoses made by the algorithm and by the clinicians. A secondary classification of the patients by the algorithm into benign versus malignant causes of obstructive jaundice performed equally well in the data base and the test sample.

Nonoperative imaging techniques in suspected biliary tract obstruction

“…Less common causes include benign strictures, chronic pancreatitis, metastatic nodes to the porta hepatis, and primary sclerosing cholangitis. Many studies have shown that clinical data such as history, physical examination, and laboratory tests can accurately identify up to 90% of patients whose jaundice is caused by extrahepatic obstruction 1–21. However, complete assessment of extrahepatic obstruction often requires the use of various imaging modalities to confirm the presence, level, and cause of obstruction, and to aid in treatment planning.…”

Differential diagnosis of jaundice: applicability of the Copenhagen Pocket Chart proved in Stockholm patients

“…Differences Using Bayes' theorem and logistic discrimination an algorithm was developed for differentiating between four diagnostic groups: acute non-obstructive (medical) jaundice, chronic non-obstructive jaundice, benign obstructive (surgical) jaundice and malignant obstructive jaundice. The details of the algorithm have been reported previously (6). It takes into account 21 items of information from the history, physical examination and routine laboratory procedures ( Fig.…”

Συμβολή Των Διαγνωστικών Μεθόδων Στη Διαφορική Διάγνωση Του Ικτέρου

“…Καλά αποτελέσματα έχουν αναφερθεί και για συστήματα τα οποία χρησιμοποιούνται για την πρόγνωση της οξείας παγκρεατίτιδας καιρούς έχουν δημοσιευθεί αλγοριθμικοί πίνακες με σκοπό τη συστηματική και αποτελεσματική εφαρμογή των διαγνωστικών μέσων και τη διευκόλυνση της πορείας προς τη διάγνωση της αιτίας του ικτέρου [136][137][138][139][140][141][142][143][144][145][146]. Πρέπει να σημειωθεί όμως, ότι με την εισαγωγή νέων διαγνωστικών μεθόδων, οι αλγοριθμικοί πίνακες υφίστανται συνεχείς τροποποιήσεις.Επίσης, ένας τέτοιος πίνακας δεν έχει εφαρμογή σε όλους τους ασθενείς.…”