Evaluation of a cardiac diagnostic program in a typical clinical setting
Evaluation of a cardiac diagnostic program in a typical clinical setting
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DOI：
10.1197/jamia.m1184
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发表时间：
2003-07-01
影响因子：
6.4
通讯作者：
Naimi, S
中科院分区：
文献类型：
--
作者：
Fraser, HSF;Long, WJ;Naimi, S
背景：心脏病计划 (HDP) 是一种新颖的计算机化诊断程序，结合了心血管生理学的计算机模型。医生可以输入标准的临床数据并接受带有解释的鉴别诊断。目的：评估 HDP 的诊断性能及其在典型临床环境中医生的可用性。设计：对教学医院内科和心脏病科的医生使用 HDP 进行前瞻性观察研究。数据来自 114 名患有多种心脏疾病的患者，由 6 名医生输入。使用了测量：敏感性、特异性和阳性预测值 (PPV)。综合性：HDP 或医生对每个病例建议的最终诊断的比例。相关性：HDP 或医生诊断正确的比例。 HDP 和医生的受试者工作特征 (ROC) 曲线 (AUC) 下面积。将性能与基于随访和进一步调查的最终诊断进行比较。结果：与最终诊断相比，HDP 比医生具有更高的敏感性（53.0% vs. 34.8%）和显着更高的综合性（57.2% vs. 39.5%，p < 0.0001）。医生的PPV和相关性（56.2%、56.0%）高于HDP（25.4%、28.1%）。结合医生和 HDP 的诊断，敏感性为 61.3%，全面性为 65.7%。这些发现对于两个收集队列以及最严重诊断的亚分析具有重要意义。 HDP 和医生的 AUC 相似。结论：心脏病项目有可能改善医生在典型临床环境中的鉴别诊断。
Context: The Heart Disease Program (HDP) is a novel computerized diagnosis program incorporating a computer model of cardiovascular physiology. Physicians can enter standard clinical data and receive a differential diagnosis with explanations.Objective: To evaluate the diagnostic performance of the HDP and its usability by physicians in a typical clinical setting.Design: A prospective observational study of the HDP in use by physicians in departments of medicine and cardiology of a teaching hospital. Data came from 114 patients with a broad range of cardiac disorders, entered by six physicians.Measurements: Sensitivity, specificity, and positive predictive value (PPV) were used. Comprehensiveness: the proportion of final diagnoses suggested by the HDP or physicians for each case. Relevance: the proportion of HDP or physicians' diagnoses that are correct. Area under the receiver operating characteristic (ROC) curve (AUC) for the HDP and the physicians. Performance was compared with a final diagnosis based on follow-up and further investigations.Results: Compared with the final diagnoses, the HDP had a higher sensitivity (53.0% vs. 34.8%) and significantly higher comprehensiveness (57.2% vs. 39.5%, p < 0.0001) than the physicians. Physicians' PPV and relevance (56.2%, 56.0%) were higher than the HDP (25.4%, 28.1%). Combining the diagnoses of the physicians and the HDPs, sensitivity was 61.3% and comprehensiveness was 65.7%. These findings were significant in the two collection cohorts and for subanalysis of the most serious diagnoses. The AUCs were similar for the HDP and the physicians.Conclusions: The heart disease program has the potential to improve the differential diagnoses of physicians in a typical clinical setting.