An international assessment of a web-based diagnostic tool in critically ill children

Thomas, Neal J.; Ramnarayan, Padmanabhan; Bell, Michael J.; Maheshwari, P.; Wilson, Shaun; Nazarian, Emily; Phipps, Lorri M.; Stockwell, David C.; Engel, Michael; Maffei, Frank A.; Vyas, Harish; Britto, Joseph

doi:10.3233/thc-2008-16204

Cited by 10 publications

(5 citation statements)

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“…In routine clinical practice, diagnostic error rates are estimated to be 1%-15% of all patient encounters. 2 4 5 30 Improvements in diagnostic accuracy as small as 4% resulted in substantial harm reduction, 31 suggesting that if the 5%-11% improvements in the diagnostic process noted in this study were transferable to routine practice, it would be meaningful.…”

Section: Discussionmentioning

confidence: 82%

“…And though more experienced clinicians generate more correct hypotheses, they are still capable of diagnostic error, 33 so late use of EDS may help them reconsider a common diagnosis that was initially overlooked-thereby functioning as a diagnostic checklist 37 38 or a way to re-evaluate their initial impressions. 39 EDS systems can help clinicians guard against search satisficing, where the first diagnosis that comes to mind is too easily accepted 31 and a differential diagnosis is not generated at all. 40 Even experienced clinicians may not recognise a correct diagnosis from the EDS list if they are unfamiliar with it or do not see its relevance to the case.…”

Section: Discussionmentioning

confidence: 99%

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Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel

et al. 2021

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BackgroundDiagnostic errors unfortunately remain common. Electronic differential diagnostic support (EDS) systems may help, but it is unclear when and how they ought to be integrated into the diagnostic process.ObjectiveTo explore how much EDS improves diagnostic accuracy, and whether EDS should be used early or late in the diagnostic process.Setting6 Canadian medical schools. A volunteer sample of 67 medical students, 62 residents in internal medicine or emergency medicine, and 61 practising internists or emergency medicine physicians were recruited in May through June 2020.InterventionParticipants were randomised to make use of EDS either early (after the chief complaint) or late (after the complete history and physical is available) in the diagnostic process while solving each of 16 written cases. For each case, we measured the number of diagnoses proposed in the differential diagnosis and how often the correct diagnosis was present within the differential.ResultsEDS increased the number of diagnostic hypotheses by 2.32 (95% CI 2.10 to 2.49) when used early in the process and 0.89 (95% CI 0.69 to 1.10) when used late in the process (both p<0.001). Both early and late use of EDS increased the likelihood of the correct diagnosis being present in the differential (7% and 8%, respectively, both p<0.001). Whereas early use increased the number of diagnostic hypotheses (most notably for students and residents), late use increased the likelihood of the correct diagnosis being present in the differential regardless of one’s experience level.Conclusions and relevanceEDS increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis appearing in the differential, and these effects persisted irrespective of whether EDS was used early or late in the diagnostic process.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel

et al. 2021

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confidence: 99%

“…While these may be the most direct method of studying the topic, it does not allow for an epidemiological description of the problem and clearly may represent a biased sample given that all patients found to have diagnostic error are dead at the time of identification. Interestingly, diagnostic assistance tools or decision supports have also been around for decades, even for pediatrics (10,11), yet delineating diagnostic error's prevalence, scope, and importance has been slow coming.In this issue of Critical Care Medicine, Cifra et al ( 12) make notable methodological advancements in exploring diagnostic errors. Using records from four U.S. PICU sites, two with combined cardiac/medical-surgical units and two noncardiac medical-surgical units, the authors randomly sampled and reviewed records from one calendar year from each site to identify patients with nonelective admissions.…”

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confidence: 99%

Scientific Progress and a Diagnostic Dilemma*

Stockwell

2023

Critical Care Medicine

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Patient safety is a mess. Soon after the 1999 publication of To Err Is Human: Building a Safer Health System (1), the fallibility of the care we deliver was noticed by the lay press and well documented. In the decades since, a consistent lack of improvement has been observed in adult medicine and pediatrics (2-6). In the last few years, two substantial, well-executed, and reported studies have found that approximately 25% of all admitted patients in the United States are harmed by the care they received or the lack of care they should have received (5,6). Of those injured, approximately a quarter to half are found to be the result of a preventable event. Within pediatrics in the last decade, similar estimates of 25-40% of admitted patients have a harm event with similar proportions of preventable events (3, 7, 8). We have considerable challenges protecting our patients from healthcare risks.A subset of these preventable events is due to diagnostic errors. Like most patient safety events, when they happen, they range in severity from near miss to deadly. These are distressful for the patient, family, and the entire healthcare team, yet these events have proven difficult to expose consistently. Diagnostic errors are often insidious and difficult to find, especially using retrospective medical record review. Early explorations in diagnostic errors compared diagnosis at the time of death to autopsy records (9). While these may be the most direct method of studying the topic, it does not allow for an epidemiological description of the problem and clearly may represent a biased sample given that all patients found to have diagnostic error are dead at the time of identification. Interestingly, diagnostic assistance tools or decision supports have also been around for decades, even for pediatrics (10,11), yet delineating diagnostic error's prevalence, scope, and importance has been slow coming.In this issue of Critical Care Medicine, Cifra et al ( 12) make notable methodological advancements in exploring diagnostic errors. Using records from four U.S. PICU sites, two with combined cardiac/medical-surgical units and two noncardiac medical-surgical units, the authors randomly sampled and reviewed records from one calendar year from each site to identify patients with nonelective admissions. The authors applied their Revised Safer Dx Instrument study tool to these nonelective admissions. This instrument consists of a series of questions for the chart reviewer regarding the likelihood of a diagnostic error. Chart review was limited to the period from PICU admission until transfer out of the unit or up to 7 days following PICU admission, whichever first. Pediatric intensivists or advanced practice providers at each site reviewed records after each were trained on the use of the instrument. Upon application of the Revised Safer Dx Instrument, records screening positive for possible diagnostic error were assessed by the lead investigators from each site for a diagnostic error at consensus meetings. Diagnostic errors were declar...

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“…The medical diagnosis tool used in this research is one of the top such tools in terms of its incorporation of evidence-based guidelines and content (W. F. Bond et al 2010). This type of tool can improve diagnosis accuracy and efficiency by outperforming doctors (Graber, Tompkins, and Holland 2009;Thomas et al 2008). It differs from more mainstream tools like WebMD or Mayo Clinic Symptom Checkers by producing probability-ranked differential diagnoses in response to userentered symptoms.…”

Section: Results: Polygraph Case Studymentioning

confidence: 99%

Automating Administration? Neutrality and its Limits in Technology-Mediated Decisions

Sack

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Appendices as supplemental documents. "Psychic X-Ray: Jigsaw," "… Fish Bowl," and "…Clockwork," oils on 16" x 20" stretched canvasses. Vera Katelyn Wilde, Dissertation-Chapter 1, p. 1/201 Neutral Competence? Polygraphy and Technology-Mediated Administrative Decisions How neutral are decision-making technologies such as lie detection in security contexts, medical diagnosis tools in healthcare, and welfare benefits administration tools in social work? The growth of bureaucracy is a core characteristic of 20 th century American politics. Administrative decision-making technologies seem to constrain bureaucratic discretion: they seem relatively rule-bound, objective, and thus bias-free. Yet existing evidence does not actually establish the neutrality of those technologies. This matters, because these technologies affect most Americans' life chances in terms of life, liberty, and the means to pursue happiness. As denizens of the information age, we already know that increases in the number of such technologies and their use are steady and large: technology pervades modern life. Specifically, as a series of recent whistleblower leaks have established, we are living in a post-9/11 era in which means for mass data collection (the Big Data revolution) have changed the parameters of technology-mediated government. But mainstream public discourse is just beginning to incorporate this knowledge, and scholars do not know how neutral administrative technologies in general really are. Decision-making technologies might be biased in three sorts of ways. First, they might systematically institutionalize cognitive biases, perhaps outside the conscious awareness of the people using them. For example, street-level bureaucrats such as police, doctors, and social workers might manifest racial bias, confirmation bias, and the combination of the two (intersectional bias), in interpreting information used to make technology-mediated decisions. Specifically, due to associations between blacks and Vera Katelyn Wilde, Dissertation-Chapter 2, p. 13/201 Truth, Lies, and Polygraph Tape: Earlier Development of the Contemporary Surveillance State "It is important to create a picture of objectivity, capability, being in charge, and above all, having the ability to ascertain if the examinee is responding truthfully or deceptively"-Stan Abrams, The Complete Polygraph Handbook, 1989. Truth, Lies, and Polygraph Tape: Later Development of the Contemporary Surveillance State "The physiology of the detainees was usually horrible due to their lack of sleep, eating, depression, and extreme temperatures."-Air Force internal document comment from an anonymous American polygrapher of Abu Ghraib detainees, on one reason why he believed polygraphs in this context to be inaccurate.

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An international assessment of a web-based diagnostic tool in critically ill children

Cited by 10 publications

References 21 publications

Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel

Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel

Scientific Progress and a Diagnostic Dilemma*

Automating Administration? Neutrality and its Limits in Technology-Mediated Decisions

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