Introducimos aqui el apartado práctico para realizar el análisis de casos clínicos con la intención de la Mejora del Diagnóstico. La ficha de recogida de datos puede aplicarse a las sesiones clínicas habituales
Conferencia de la Dra. Tamara Moreno. III Workshop Foro Osler
Clinical reasoning, Diagnostic Improvement, Patient Safety, are concepts usually explained like independent subjects. We want to define a new general concept , Clinical Intelligence, as a way to explain the interaction between these areas to resolve the clinical problem of a patient in a more rational, sustainable, safe and logical way.
A one page article about key aspects to improve diagnostic skills.
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CLINICAL CASE: A 23 year-old woman went to the ED because she was unable to maintain her head in the right position. She worked in a supermarket and the symptoms developed at the end of the day together with a feeling of “weekness” in both arms.
EVOLUTION: At least in three occasions she was discharged from the ED with diagnoses such as: torticollis, muscle contracture. At the last visit a complete medical interview and physical examination evidenced a youg patient with an absolute impairement to keep her head and neck up, with no other main signs after a neurological examination.
FINAL DIAGNOSIS: Dropped head syndrome. The clinical picture was coincident with a mild enlargement of her thymus, suggesting a myasthenic problem, but antibodies has been negative.
TYPE OF DIAGNOSTIC ERROR: Diagnostic Delay
Cognitive aspects: doctors that see young patients in the ED with uncommon symptoms and with a good general health status could think that there is not an important problem, putting “labels” on these patients.
Improving strategy: A complete anamnesis and physical examination together with an open attitude is a key aspect for making a correct diagnosis.
Dropped head syndrome (DHS) is characterized by severe kyphotic deformity of the cervico-thoracic spine. It is a relatively rare condition with a broad differential diagnosis. The conditions linked with DHS can be categorized into neurological, neuromuscular, muscular, and other causes.
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