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首页> 外文期刊>The American journal of emergency medicine >'Sick' or 'not-sick': Accuracy of System 1 diagnostic reasoning for the prediction of disposition and acuity in patients presenting to an academic ED
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'Sick' or 'not-sick': Accuracy of System 1 diagnostic reasoning for the prediction of disposition and acuity in patients presenting to an academic ED

机译：“生病”或“不生病”：系统1诊断推理的准确性，可预测就读学术ED的患者的处置倾向和敏锐度

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摘要

Objective System 1 decision-making is fast, resource economic, and intuitive (eg, "your gut feeling") and System 2 is slow, resource intensive, and analytic (eg, "hypothetico-deductive"). We evaluated the performance of disposition and acuity prediction by emergency physicians (EPs) using a System 1 decision-making process. Methods We conducted a prospective observational study of attending EPs and emergency medicine residents. Physicians were provided patient demographics, chief complaint, and vital sign data and made two assessments on initial presentation: (1) likely disposition (discharge vs admission) and (2) "sick" vs "not-sick". A patient was adjudicated as sick if he/she had a disease process that was potentially life or limb threatening based on pre-defined operational, financial, or educationally derived criteria. Results We obtained 266 observations in 178 different patients. Physicians predicted patient disposition with the following performance: sensitivity 87.7% (95% CI 81.4-92.1), specificity 65.0% (95% CI 56.1-72.9), LR+ 2.51 (95% CI 1.95-3.22), LR - 0.19 (95% CI 0.12-0.30). For the sick vs not-sick assessment, providers had the following performance: sensitivity 66.2% (95% CI 55.1-75.8), specificity 88.4% (95% CI 83.0-92.2), LR + 5.69 (95% CI 3.72-8.69), LR - 0.38 (95% CI 0.28-0.53). Conclusion EPs are able to accurately predict the disposition of ED patients using system 1 diagnostic reasoning based on minimal available information. However, the prognostic accuracy of acuity prediction was limited.
机译：目标系统1的决策是快速的，资源经济的，直观的（例如，“直觉”），而系统2的决策是缓慢的，资源密集的和分析的（例如，“假设演绎”）。我们使用系统1决策过程评估了急诊医师（EP）的处置和敏锐度预测的性能。方法我们对参与的EP和急诊医学居民进行了一项前瞻性观察研究。向医生提供了患者的人口统计学信息，主要主诉和生命体征数据，并在首次就诊时进行了两项评估：（1）可能的处境（出院与入院）和（2）“病”与“不病”。如果患者/患者的疾病过程可能会根据预定的手术，财务或教育水平而导致生命或肢体受到威胁，则被判定为患病。结果我们在178名不同患者中获得了266项观察结果。医师可预测患者的治疗情况，其表现如下：敏感性87.7％（95％CI 81.4-92.1），特异性65.0％（95％CI 56.1-72.9），LR + 2.51（95％CI 1.95-3.22），LR-0.19（95％ CI 0.12-0.30）。对于患病与不患病评估，提供者的表现如下：敏感性66.2％（95％CI 55.1-75.8），特异性88.4％（95％CI 83.0-92.2），LR + 5.69（95％CI 3.72-8.69） ，LR-0.38（95％CI 0.28-0.53）。结论EP能够基于最少的可用信息，使用系统1诊断推理来准确预测ED患者的病情。但是，视力预测的预后准确性有限。

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