Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Health Care Processes and Decision Making
Lecture:Gathering data and analyzing findings
Making a diagnosis
The impact of EHRs and technology on clinical decision-making
Slide content:Patterns of Data in Diagnosis Especially Neurologic Diagnosis Topographic pattern Locate lesion in nervous system Peripheral nerves, plexus, spine, brain Temporal pattern Pace of appearance and resolution of symptoms Pathophysiologic process Clinical contextthe company it keeps Other symptoms (e.g., fever) Comorbidities (e.g., valvular heart disease) Past history (e.g., smoking) 8
Slide notes:Especially in neurologic diagnoses, clinicians may use the topographic pattern, the temporal pattern, and the clinical context. The topographic pattern refers to mapping symptoms to the specific location in the brain or nervous system responsible for that function. For example, the patients neurologic symptoms and signs on physical examination can be correlated with the exact location in the nervous system that might be responsible for these symptoms. The same is true for diseases of the nervous system that occur outside of the brain, such as in the spinal cord. In analyzing the temporal pattern, a clinician looks at the pace that symptoms appear or resolve to understand the underlying pathophysiological [ path -oh- fiz - ee -uh- loj - ik-uhl ] process that might be causing the problem. Given exactly the same set of symptomsfor example, numbness and weakness in the right arm and right side of the facethe clinician can infer what kind of process might be involved by considering the pace at which these symptoms appear. Seizures are essentially an electrical process and take place over a matter of minutes. So when a patient reports symptoms that appear and then disappear within minutes, it may well have been a seizure. Vascular events include stroke, transient ischemic [ ih- skee -mik ] attack, and migraine, and these events generally take place over minutes to hours. Therefore, if a patient presents with the same symptoms but they appear over many minutes or last several hours, they may be due to a vascular process. If these symptoms go away entirely, it may be a transient ischemic attack. If some symptoms persist indefinitely with permanent damage, then its a stroke. When symptoms appear over many hours to days or even weeks, this suggests an infectious cause. A brain abscess [ ab- sess ], for example, might cause the same symptoms of numbness, tingling, and weakness, but it evolves over several hours or days. If these same symptoms were to appear gradually over many months, in a pattern of more or less relentless progression, then they may be due to a neoplasm or cancerous growth. Neurodegenerative diseases occur slowly over many months or years. An example of such a disease that would cause the same set of neurologic symptoms would be amyotrophic [uh- my- oh- troh - fik ] lateral sclerosis [ skli - roh -sis] . Finally, some conditions are characterized by waxing and waning symptoms, superimposed on an underlying yet slowly progressive worsening of symptoms; this suggests a disease such as multiple sclerosis. In short, the neurologic diagnosis depends on combining the topography of the condition, indicating which part of the brain is involved, with the temporal pattern, which suggests what kind of process may be causing the trouble. Finally, the clinical context helps clinicians understand what non-neurologic process might be causing the condition. For example, a patient who has a fever is more likely to have an infection, whereas a patient with a comorbid [ ko- mor- bihd ] illness, such as valvular [ val -vyuh-ler ] heart disease, is more likely to have a heart condition as the cause, and a patient who smokes cigarettes is more likely to have cancer as the cause. 8