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首页> 外文期刊>JMIR Medical Informatics >Differential Diagnosis Assessment in Ambulatory Care With an Automated Medical History–Taking Device: Pilot Randomized Controlled Trial
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Differential Diagnosis Assessment in Ambulatory Care With an Automated Medical History–Taking Device: Pilot Randomized Controlled Trial

机译：采用自动化病史诊断装置的差异诊断评估：试点随机对照试验

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Background Automated medical history–taking devices (AMHTDs) are emerging tools with the potential to increase the quality of medical consultations by providing physicians with an exhaustive, high-quality, standardized anamnesis and differential diagnosis. Objective This study aimed to assess the effectiveness of an AMHTD to obtain an accurate differential diagnosis in an outpatient service. Methods We conducted a pilot randomized controlled trial involving 59 patients presenting to an emergency outpatient unit and suffering from various conditions affecting the limbs, the back, and the chest wall. Resident physicians were randomized into 2 groups, one assisted by the AMHTD and one without access to the device. For each patient, physicians were asked to establish an exhaustive differential diagnosis based on the anamnesis and clinical examination. In the intervention group, residents read the AMHTD report before performing the anamnesis. In both the groups, a senior physician had to establish a differential diagnosis, considered as the gold standard, independent of the resident’s opinion and AMHTD report. Results A total of 29 patients were included in the intervention group and 30 in the control group. Differential diagnosis accuracy was higher in the intervention group (mean 75%, SD 26%) than in the control group (mean 59%, SD 31%; P=.01). Subgroup analysis showed a between-group difference of 3% (83% [17/21]-80% [14/17]) for low complexity cases (1-2 differential diagnoses possible) in favor of the AMHTD (P=.76), 31% (87% [13/15]-56% [18/33]) for intermediate complexity (3 differential diagnoses; P=.02), and 24% (63% [34/54]-39% [14/35]) for high complexity (4-5 differential diagnoses; P=.08). Physicians in the intervention group (mean 4.3, SD 2) had more years of clinical practice compared with the control group (mean 5.5, SD 2; P=.03). Differential diagnosis accuracy was negatively correlated to case complexity (r=0.41; P=.001) and the residents’ years of practice (r=0.04; P=.72). The AMHTD was able to determine 73% (SD 30%) of correct differential diagnoses. Patient satisfaction was good (4.3/5), and 26 of 29 patients (90%) considered that they were able to accurately describe their symptomatology. In 8 of 29 cases (28%), residents considered that the AMHTD helped to establish the differential diagnosis. Conclusions The AMHTD allowed physicians to make more accurate differential diagnoses, particularly in complex cases. This could be explained not only by the ability of the AMHTD to make the right diagnoses, but also by the exhaustive anamnesis provided.
机译：背景技术自动化历史验证设备（AMHTDS）正在新兴工具，通过提供具有详尽无遗，高质量，标准化的厌氧和鉴别诊断的医生来提高医疗咨询质量。目的本研究旨在评估AMHTD在门诊服务中获得准确的差异诊断的有效性。方法采用试点随机对照试验，涉及59名患者呈现给紧急外科单位的患者，患有影响四肢，背部和胸壁的各种条件。居民医师被随机分为2组，一个由AMHTD的辅助，一个没有访问设备。对于每位患者，被要求基于厌氧和临床检查建立详尽鉴别诊断。在干预组中，居民在执行anamnesis之前阅读AMHTD报告。在两个团体中，高级医生必须建立鉴别诊断，被视为黄金标准，独立于居民的意见和AMHTD报告。结果共有29名患者纳入干预组和对照组30例。干预组（平均75％，SD 26％）差异诊断精度高于对照组（平均59％，SD 31％; P = .01）。亚组分析显示，对于低复杂性病例（1-2个差异诊断），基团分析显示3％（83％[17/21] -80％[14/17]）（1-2个差异诊断），有利于AMHTD（p = .76 ），31％（87％[13/15] -56％[18/33]）用于中间复杂性（3个差异诊断; p = .02），24％（63％[34/54] -39％[ 14/35]）对于高复杂度（4-5个差分诊断; P = .08）。干预组的医生（平均4.3，SD 2）与对照组相比具有多年的临床实践（平均5.5，SD 2; P = .03）。差分诊断精度与案例复杂性（r = 0.41; p = .001）和居民多年的实践（r = 0.04; p = .72）负相关。 AMHTD能够确定73％（SD 30％）的正确差异诊断。患者满意度良好（4.3 / 5），26例患者中有26例（90％）认为它们能够准确描述其症状学。在29例中的8例（28％）中，居民认为AMHTD有助于建立鉴别诊断。结论AMHTD允许医生制作更准确的差异诊断，特别是在复杂的病例中。这不仅可以通过AMHTD做出正确诊断的能力，而且可以通过提供的详尽厌氧来解释。

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