Global assessment of patients--a bedside study. I: The influence of physical findings on the global assessment.

Three physicians selected ten basic physical findings for a study of diagnostic decision making in the global assessment of patients. The physicians independently examined 201 hospital in-patients for the presence of each of the findings and concluded their assessment with a global evaluation of whether the patient appeared ill. Each of the ten findings were used by at least one of the physicians in his overall assessment of the patient. All the observers considered 'looking older than age', 'trouble with breathing', 'cyanosis', and 'anaemia' important, but disagreed in their use of the remaining findings (P less than 0.01). Agreement in the global clinical assessment is an essential prerequisite to uniformity in the approach to the patient.