On The Establishment Of Clinical Thinking Of General Medical Students From The Diagnosis Of Fever Of Unknown Origin

AimsStarting from the common symptom "fever" in the community,116 cases of fever of unknown origin(hereinafter referred to as FUO)in the first affiliated Hospital of Soochow University were studied retrospectively,and the diagnostic ideas of FUO suitable for general practitioners were discussed,so as to improve the clinical thinking ability of general medical students.MethodsA total of 211 patients admitted to the First Affiliated Hospital of Soochow University from June 2015 to June 2019 with FUO were selected,95 cases with incomplete data and non-compliance with the inclusion criteria were excluded,and the final collection was in line with the purpose of this study A total of 116 cases.Cases with incomplete data were excluded,and a total of 116 cases that met the purpose of this study were collected.Divide the causes of FUO into five groups:infectious disease group,non-infectious inflammatory disease group,"other diseases" group(mainly including subacute thyroiditis,histiocytic necrotizing lymphadenitis and other "other diseases" that cause FUO),neoplastic disease group and undiagnosed group.On the basis of data collection and grouping:(1)Describe the general information of 116 cases of FUO,the overall distribution of FUO etiology,the relationship between FUO etiology and gender,age,fever duration,fever degree,and whether diabetes is combined;(2)Combining the results of FUO case analysis,starting from the etiology,to explore the FUO clinical diagnosis ideas suitable for general practitioners.ResultsOf 116 patients with FUO,104 had a definite diagnosis(89.66%),and 12 had an undiagnosed diagnosis(10.34%).The causes of clearly diagnosed FUO patients were 64 cases of infectious diseases(55.17%),20 cases of non-infectious inflammatory diseases(17.24%),11 cases of "other diseases"(9.49%)and 9 cases of neoplastic diseases(7.76%).Among infectious diseases,bacterial infections of the respiratory system are the most common;adult still diseases are still the most common in non-infectious inflammatory diseases;among neoplastic diseases,solid tumors show a decreasing trend;on the contrary,hematological tumors have an increasing trend,and lymphomas mainly;subacute thyroiditis and histiocytic necrotizing lymphadenitis are the most common in the "other diseases"group.Among 116 patients with FUO,men accounted for more than women.There is no significant difference in the etiology distribution of FUO between different genders(P>0.05),but the difference in the etiology of FUO young men and FUO young women is statistically significant(P<0.05).Infectious diseases are the most common etiology in all age groups,Among them,the proportion of infectious diseases was the highest in the adolescent group(80%).Non-infectious inflammatory diseases and neoplastic diseases are not distributed in the adolescent group;infectious diseases are mainly distributed in the elderly group.The etiology distribution of FUO at different ages was not statistically different(P>0.05),but the difference in etiology of FUO young women and FUO elderly women was statistically significant(P<0.05).Infectious diseases are the primary cause in each fever degree group,and the proportion increases with the increase of fever degree;the proportion of neoplastic diseases decreases with the increase of fever degree.The etiology distribution of FUO in groups with different degrees of fever was not statistically different(P>0.05).When the fever duration of FUO patients is less than 1 month,the proportion of infectious diseases increases,while when the fever duration is more than 1 month,the proportion of non-infectious diseases increases.The distribution of FUO etiology in different fever duration was not statistically different(P>0.05).Twelve patients with FUO were diagnosed with diabetes(11.54%).There was no significant difference in the distribution of infectious diseases and non-infectious diseases with or without diabetes(P>0.05).Conclusions1.There are many causes in patients with FUO,among which infectious disease is still the most common cause.2.A comprehensive analysis of the etiological composition of FUO and its relationship with sex,age,fever duration,fever degree,diabetes mellitus has a certain guiding significance for the clinical diagnosis of FUO.3.The diagnostic idea of FUO suitable for general practitioners is qualitative-positioning-cause analysis,namely:(1)familiar with the etiology of FUO,qualitative analysis;(2)combined with the main clinical manifestations and auxiliary examination results,positioning analysis;(3)comprehensive dynamic evaluation,cause analysis.