Document Detail

Validation of a diagnostic reminder system in emergency medicine: a multi-centre study.
MedLine Citation:
PMID:  17711936     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Diagnostic error is a significant problem in emergency medicine, where initial clinical assessment and decision making is often based on incomplete clinical information. Traditional computerised diagnostic systems have been of limited use in the acute setting, mainly due to the need for lengthy system consultation. We evaluated a novel web-based reminder system, which provides rapid diagnostic advice to users based on free text search terms.
METHODS: Clinical data collected from patients presenting to three emergency departments with acute medical problems were entered into the diagnostic system. The displayed results were assessed against the final discharge diagnoses for patients who were admitted to hospital (diagnostic accuracy) and against a set of "appropriate" diagnoses for each case provided by an expert panel (potential utility).
RESULTS: Data were collected from 594 patients (53.4% of screened attendances). Mean age was 49.4 years (95% CI 47.7 to 51.1) and the majority had significant past illnesses. Most were assessed first by junior doctors (70%) and 266/594 (44.6%) were admitted to hospital. Overall, the diagnostic system displayed the final discharge diagnosis in 95% of inpatients and 90% of "must-not-miss" diagnoses suggested by the expert panel. The discharge diagnosis appeared within the first 10 suggestions in 78% of cases.
CONCLUSIONS: The Isabel diagnostic aid has been shown to be of potential use in reminding junior doctors of key diagnoses in the emergency department. The effects of its widespread use on decision making and diagnostic error can be clarified by evaluating its impact on routine clinical decision making.
Padmanabhan Ramnarayan; Natalie Cronje; Ruth Brown; Rupert Negus; Bill Coode; Philip Moss; Taj Hassan; Wayne Hamer; Joseph Britto
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  24     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-22     Completed Date:  2007-09-28     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  619-24     Citation Subset:  IM    
Children's Acute Transport Service, London WC1R 4LL, UK.
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MeSH Terms
Analysis of Variance
Chi-Square Distribution
Decision Support Systems, Clinical*
Diagnosis, Computer-Assisted / methods*
Diagnosis, Differential
Diagnostic Errors / prevention & control*
Emergency Service, Hospital / organization & administration*
Middle Aged
Prospective Studies
Reminder Systems*
User-Computer Interface

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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