PERFORMANCE OF 4 COMPUTER-BASED DIAGNOSTIC SYSTEMS
PERFORMANCE OF 4 COMPUTER-BASED DIAGNOSTIC SYSTEMS
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DOI：
10.1056/nejm199406233302506
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发表时间：
1994-06-23
影响因子：
158.5
通讯作者：
TAUNTON, D
中科院分区：
文献类型：
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作者：
BERNER, ES;WEBSTER, GD;TAUNTON, D
背景以计算机为基础的诊断系统在商业上可以买到，但对其性能的评价有限。我们评估了四种内科诊断系统的诊断能力：Dxplain、Iliad、Meditel和QMR。10位专家临床医生创建了一组105个涉及实际患者的具有诊断挑战性的临床病例摘要。将临床数据输入每个程序，并使用程序开发人员提供的词汇表。每个系统都为每个患者产生了一个可能的诊断排名列表，专家组也是如此。我们计算了每个计算机程序的几个性能指标的分数。没有一个计算机程序在所有性能指标上都比其他程序得分更高。在所有病例和所有程序中，正确诊断的比例范围为0.52 - 0.71，平均相关诊断比例范围为0.19 - 0.37。平均而言，在专家最初列出的合理诊断名单上，只有不到一半的诊断是由任何一个程序提出的。然而，每个程序平均建议每个病例大约两个额外的诊断，专家们发现相关的，但最初没有考虑。结果提供了这些计算机程序的优势和局限性的配置文件。这些程序应该由能够识别和使用相关信息并忽略可能产生的不相关信息的医生使用。
Background. Computer-based diagnostic systems are available commercially, but there has been limited evaluation of their performance. We assessed the diagnostic capabilities of four internal medicine diagnostic systems: Dxplain, Iliad, Meditel, and QMR.Methods. Ten expert clinicians created a set of 105 diagnostically challenging clinical case summaries involving actual patients. Clinical data were entered into each program with the vocabulary provided by the program's developer. Each of the systems produced a ranked list of possible diagnoses for each patient, as did the group of experts. We calculated scores on several performance measures for each computer program.Results. No single computer program scored better than the others on all performance measures. Among all cases and all programs, the proportion of correct diagnoses ranged from 0.52 to 0.71, and the mean proportion of relevant diagnoses ranged from 0.19 to 0.37. On average, less than half the diagnoses on the experts' original list of reasonable diagnoses were suggested by any of the programs. However, each program suggested an average of approximately two additional diagnoses per case that the experts found relevant but had not originally considered.Conclusions. The results provide a profile of the strengths and limitations of these computer programs. The programs should be used by physicians who can identify and use the relevant information and ignore the irrelevant information that can be produced.