Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation.
Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation.
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DOI：
10.2196/31810
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发表时间：
2022-05-10
影响因子：
7.4
通讯作者：
Feufel, Markus A.
中科院分区：
文献类型：
--
作者：
Schmieding, Malte L.;Kopka, Marvin;Schmidt, Konrad;Schulz-Niethammer, Sven;Balzer, Felix;Feufel, Markus A.
症状检查器是帮助非专业人士自我评估其医疗投诉的紧迫性和潜在原因的数字工具。它们被广泛使用，但面临患者和医疗保健专业人员的担忧，尤其是其准确性。 2015 年的一项具有里程碑意义的研究通过案例小插图证实了这些担忧，以证明症状检查人员在分类评估中经常犯错。本研究旨在重新审视具有里程碑意义的指数研究，以调查自 2015 年以来症状检查人员的能力是否以及如何发展，以及它们目前与外行的独立分诊评估相比如何。 2020 年初，我们搜索了提供分诊建议的智能手机和基于网络的应用程序。我们根据与索引研究相同的 45 个案例插图评估了这些应用程序。使用描述性统计数据，我们将我们的发现与指数研究的结果以及外行分类能力的公开数据进行了比较。我们检索了 22 名提供分诊建议的症状检查员。 2020 年的中位分诊准确率（55.8%，IQR 15.1%）接近 2015 年（59.1%，IQR 15.5%）。与 2015 年的应用程序（赔率 2.82:1）相比，2020 年的应用程序的风险规避程度较低（赔率 1.11:1，过度分类错误与分类不足错误的比率），漏掉了超过 40% 的紧急情况。在决定是否需要紧急护理或自我护理是否足够方面，很少有应用程序能胜过外行。在这两个决定上，没有任何应用程序比外行人表现得更好。平均而言，症状检查人员的分诊性能在 5 年中没有得到改善。它在 2 个用例中有所下降（关于何时需要紧急护理以及何时暂时不需要医疗护理的建议）。然而，症状检查人员的分类能力差异很大。向症状检查人员寻求建议是否有益取决于所选的应用程序以及要回答的具体问题。未来的研究应该开发资源（例如案例片段存储库）来持续、独立地审核症状检查人员的能力，并就何时以及向谁推荐他们提供指导。
Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment. This study aims to revisit the landmark index study to investigate whether and how symptom checkers’ capabilities have evolved since 2015 and how they currently compare with laypersons’ stand-alone triage appraisal. In early 2020, we searched for smartphone and web-based applications providing triage advice. We evaluated these apps on the same 45 case vignettes as the index study. Using descriptive statistics, we compared our findings with those of the index study and with publicly available data on laypersons’ triage capability. We retrieved 22 symptom checkers providing triage advice. The median triage accuracy in 2020 (55.8%, IQR 15.1%) was close to that in 2015 (59.1%, IQR 15.5%). The apps in 2020 were less risk averse (odds 1.11:1, the ratio of overtriage errors to undertriage errors) than those in 2015 (odds 2.82:1), missing >40% of emergencies. Few apps outperformed laypersons in either deciding whether emergency care was required or whether self-care was sufficient. No apps outperformed the laypersons on both decisions. Triage performance of symptom checkers has, on average, not improved over the course of 5 years. It decreased in 2 use cases (advice on when emergency care is required and when no health care is needed for the moment). However, triage capability varies widely within the sample of symptom checkers. Whether it is beneficial to seek advice from symptom checkers depends on the app chosen and on the specific question to be answered. Future research should develop resources (eg, case vignette repositories) to audit the capabilities of symptom checkers continuously and independently and provide guidance on when and to whom they should be recommended.
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影响因子：
3.3
作者：
Lunn, Peter D.;Timmons, Shane;McGowan, Feidhlim P.
通讯作者：
McGowan, Feidhlim P.
DOI：
10.1093/jamia/ocaa051
发表时间：
2020-06-01
影响因子：
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作者：
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作者：
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影响因子：
15.2
作者：
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通讯作者：
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