Specialist discrimination of toxic exposure severity at a poison control center
Specialist discrimination of toxic exposure severity at a poison control center
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DOI：
10.1080/15563650903140407
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发表时间：
2009-01-01
影响因子：
3.3
通讯作者：
Jasti, Srichand
中科院分区：
文献类型：
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作者：
Poynton, Mollie R.;Bennett, Heather K. W.;Jasti, Srichand
背景感知严重性已被证明会影响电话分诊的决策过程。然而，毒物信息专家（SPIs）对毒物暴露严重程度的看法的准确性是未知的。objective.本研究的目的是描述的能力的SPI预测严重程度的医疗结果的基础上获得的信息在最初的中毒控制中心的电话。方法.本研究分析了一个区域毒物控制中心的22,576例人类毒物暴露病例。在初次调用时，SPI分配了预测的严重性评级。然后，SPI在关闭每个病例时分配医疗结局评级。排除未编码、未随访和确认未暴露的动物暴露。结果对于更严重与不太严重病例的总体SPI区分，A（z）= 0.94，95%置信区间不对称（0.87，0.97），表明区分良好。SPIs在区分主要效应和其他效应方面的灵敏度为0.62。区分中度、重大或致死性效应与轻微效应或无效应的假阴性率为0.32，灵敏度= 0.68。结论. SPIs预测暴露严重程度的总体能力非常好，但对于不太常见、更严重的病例，准确性较差。更好地了解SPI的决策过程，包括感知的严重性和决策策略之间的关系，是必要的教育战略和决策支持技术的发展。
Background. Perceived severity has been shown to affect decision-making processes in telephone triage. However, the accuracy of specialists in poison information's (SPIs') perceptions of severity of poison exposures is unknown. Objective. The purpose of this study was to describe the ability of SPIs to predict severity of medical outcome on the basis of the information obtained during the initial poison control center's phone call. Methods. This study analyzed 22,576 cases of human poison exposure in one regional poison control center. At the time of the initial call, SPIs assigned a predicted severity rating. SPIs then assigned a medical outcome rating when closing each case. Animal exposures not coded, not followed, and confirmed nonexposures were excluded. Results. For overall SPI's discrimination of more severe versus less severe cases, A(z) = 0.94 with asymmetric 95% confidence intervals (0.87, 0.97), indicating excellent discrimination. The sensitivity of SPIs in discriminating a major effect from any other effect was 0.62. The false-negative rate for discrimination of a moderate, major, or fatal effect from a minor effect or no effect was 0.32, with sensitivity = 0.68. Conclusions. The overall ability of the SPIs to predict exposure severity is excellent but less accurate with less frequently encountered, more severe cases. A better understanding of SPI's decision-making processes, including the relationship between perceived severity and decision-making strategies, is necessary for the development of educational strategies and decision support technologies.