Altogether, 442 eligible admitted patients (mean [SD] age, 66.9 [17.7] years; 51.4% male) were evaluated. Previous comorbidities were common (mean [SD] number, 1.8 [1.4]; 100 of 442 had none) including hypertension (57%), diabetes mellitus (34%), coronary disease (26%), stroke (16%), renal dysfunction (estimated glomerular filtration rate <60) (35%), and chronic lung disease (14%). Mean (SD) length of hospital stay was 4.5 (7.2) days. All patients had basic blood and urine tests performed in the ED, but only 15.5% had an ancillary test other than ECG and CXR (computed tomography, 11.8%; ultrasonography, 3.7%). The SR examined all patients within mean 14 hours of admission, spending approximately 40 minutes per patient (HP, ≤25 minutes). Follow-up and final diagnoses were obtained at a mean (SD) 2.0 (0.7) months after discharge and included a wide, diverse spectrum of illnesses typical of a department of general internal medicine. The SR was correct in 354 of 442 diagnoses (80.1%). The HPs made correct diagnoses in 373 patients (84.4%). They made identical correct diagnoses in 327 cases (73.9%); both were wrong in 42 patients (9.5%) (P = .04). The modalities considered to have been most useful in establishing the diagnosis were similar for both (Table). The patient's history emerged as the key element in formulating diagnosis either alone (approximately 20% of all diagnoses), in combination with the patient's examination (another 40%, approximately), or in addition to the basic tests with or without the physical examination (33%). The examination or basic tests alone were very seldom helpful. Used in conjunction, the physical examination doubled the diagnostic power of the history (19.5% to 39.0%; Table). The basic tests added a further 33%. Imaging was infrequently used in the ED (mainly head computed tomography) and had added little to determining diagnoses, being considered valuable in approximately 1 in 3 patients who had computed tomography performed.