Triage accuracy of online symptom checkers for Accident and Emergency Department patients
Triage accuracy of online symptom checkers for Accident and Emergency Department patients
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DOI：
10.1177/1024907919842486
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发表时间：
2020-07-01
影响因子：
0.6
通讯作者：
Leung, Ling-Pong
中科院分区：
文献类型：
--
作者：
Yu, Stephanie Wing Yin;Ma, Andre;Leung, Ling-Pong
背景：急诊科的过度使用是一个日益严重的医疗挑战。在线症状检查器可以帮助缓解这一挑战，因为它允许患者在去急诊室之前进行自我分诊。目的：本研究旨在评估在线症状检查器的分类准确性，这将有助于确定症状检查器在急诊科设置中的潜在作用。方法：随机抽取香港玛丽医院急症室病历100份。纳入标准为2016年在玛丽医院急症室就诊的18岁以上患者。症状检查器By和FamilyDoctor被选为代表性工具。每个症状检查员为每个病例记录生成一个分诊建议。然后，与分诊护士分配的分诊类别相比较，使用几个结果指标来评估每个症状检查员的分诊准确性：总体敏感度、对紧急病例的敏感度和对非紧急病例的特异度。结果：结果显示，总体分诊准确率高于FamilyDoctor(分别为74%和50%)，但两个检查者对急诊病例(分别为70%和45%)不够敏感，阴性预测值较低(分别为43%和24%)。结论：在目前的状态下，症状检查器还不适合作为急诊科分诊方案的替代方案，因为它们的总体敏感度和阴性预测值较低。然而，症状检查器在其他方面可能是急症室有用的辅助工具，例如在病人到达之前提供更多信息，以简化急症室的分流和准备程序。
Background: Overutilisation of the Accident and Emergency Department is an increasingly serious healthcare challenge. Online symptom checkers could help alleviate this challenge by allowing patients to self-triage before visiting the Accident and Emergency Department. Objectives: This study aimed to assess the triage accuracy of online symptom checkers, which would help determine the potential roles of symptom checkers in an Accident and Emergency Department setting. Methods: A total of 100 random Accident and Emergency Department records were sampled from the Queen Mary Hospital in Hong Kong. The inclusion criteria were patients over the age of 18 attending the Queen Mary Hospital Accident and Emergency Department in 2016. Symptom checkers byand FamilyDoctor were selected as representative tools. One triage recommendation was generated by each symptom checker for each case record. Each symptom checker's triage accuracy was then evaluated using a few outcome measures: overall sensitivity, sensitivity for emergency cases and specificity for non-emergency cases, when compared with the triage categories assigned by the triage nurses. Results: The results showed thathad a higher overall triage accuracy than FamilyDoctor (74% and 50%, respectively), but both checkers are inadequately sensitive to emergency cases (70% and 45%, respectively) with low negative predictive values (43% and 24%, respectively). Conclusion: In their current states, symptom checkers are not yet suitable as alternatives to Accident and Emergency Department triage protocols due to their low overall sensitivities and negative predictive values. However, symptom checkers might serve as useful Accident and Emergency Department adjuncts in other ways, such as to provide more information prior to a patient's arrival to streamline the triage and preparation process at the Accident and Emergency Department.