A randomized controlled trial of online symptom searching to inform patient generated differential diagnoses
A randomized controlled trial of online symptom searching to inform patient generated differential diagnoses
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DOI：
10.1038/s41746-019-0183-0
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发表时间：
2019-11-11
影响因子：
15.2
通讯作者：
Parakh, Kapil
中科院分区：
文献类型：
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作者：
Martin, Seth S.;Quaye, Emmanuel;Parakh, Kapil
患者在线健康搜索现在很常见，然而，患者生成的新症状差异的准确性和患者焦虑的可能性是令人担忧的。我们的主要目的是确定患者产生的新症状的差异与不在线搜索的准确性，其次，评估搜索对焦虑水平的影响。在候诊室就诊前，将300名有新症状的患者以1：1：1的比例随机分配到Google搜索，使用健康相关功能，包括症状搜索工具与Google搜索，禁用健康相关功能与不搜索。参与者年龄在18岁或以上，并在城市学术医疗中心的急诊室出现新的低敏度症状，这些症状不是由于慢性疾病的恶化。搜索组可以在平板电脑/智能手机上访问Google搜索，无论是否具有健康相关功能。两个搜索组都可以访问任何网站;与健康相关的功能使患者获得常见的诊断和医生验证的信息。主要结局是通过匹配临床医生鉴别诊断中前三名诊断中的至少两个来评估患者生成的鉴别诊断的准确性。次要结果是焦虑的视觉模拟量表。患者的中位年龄为33.1岁（IQI 26.2-45.9），60%为女性，63%为黑人，82%为高中或以下学历，45.7%报告在就诊前进行了在线搜索。搜索组患者在线搜索的平均时间为3.82（2.53-5.72）分钟。每组中与三种临床医生诊断中至少两种匹配的患者比例相似：使用Google搜索有和没有健康相关功能的患者比例分别为27.0%和28.3%，而无搜索组的患者比例为23.8%。搜索组患者与非搜索组患者匹配>= 2/3诊断的几率相似[OR（95%CI）：1.23（0.70-2.13），p = 0.47]。在线搜索的焦虑没有变化。总之，在候诊室进行简短的在线搜索并不能提高患者对新症状的鉴别诊断的准确性。患者焦虑没有增加，为后续工作提供了保证，以完善和调查在线症状搜索工具。
Patient online health searching is now commonplace, however, the accuracy of patient generated differentials for new symptoms and potential for patient anxiety are concerns. We aimed primarily to determine the accuracy of patient generated differentials for new symptoms with and without online searching, and secondarily, to evaluate the impact of searching on anxiety levels. In the waiting room prior to seeing a clinician, 300 patients with new symptoms were randomly assigned 1:1:1 to Google searching with health related features including a symptom search tool vs Google searching with health related features disabled vs no searching. Participants were 18 years or older and presenting to the emergency department of an urban academic medical center with new low-acuity symptoms that were not due to exacerbation of a chronic condition. Search groups received access on a tablet/smartphone to Google searching with or without health related features. Both search groups could access any websites; health related features led the patient to common diagnoses and physician-validated information. The primary outcome was accuracy of the patient generated differential assessed by matching at least two of the top three diagnoses on the clinician's differential. A secondary outcome was anxiety by a visual analogue scale. Patients were a median of 33.1 (IQI 26.2-45.9) years old, 60% women, 63% black, 82% had a high school education or less, and 45.7% reported having performed an online search prior to presentation. Search group patients spent a median of 3.82 (2.53-5.72) minutes searching online. Similar proportions of patients in each group matched at least two of three clinician diagnoses: 27.0% and 28.3% for Google searching with and without health related features vs 23.8% in the no search group. Patients in the search groups had a similar odds of matching >= 2/3 diagnoses as the no search group [OR (95% CI): 1.23 (0.70-2.13), p = 0.47]. Anxiety was unchanged with online searching. In conclusion, brief online searching in the waiting room did not improve accuracy of patient generated differential diagnoses for new symptoms. The absence of an increase in patient anxiety provides reassurance for subsequent work to refine and investigate online symptom search tools.