Building a New Model for Diagnosis of ED Dizzy Patients

超出所提供的空间。 本研究的目的是提高因头晕就诊于急诊科[艾德]的患者的诊断水平，其中一些患者被误诊，可能导致严重的医疗后果。头晕患者的评估的流行诊断范例是基于“病理生理学”的方法。这种方法开始寻找病因，假设症状的性质（眩晕、晕厥前期、失衡或非特异性头晕）反映了潜在的病理生理机制（眩晕=前庭，晕厥前期=心血管，失衡=神经，非特异性=精神）。虽然这一假设往往成立，“病理生理”的方法要求在每个器官系统，而不仅仅是一个症状质量的建议，彻底的病因搜索。这种策略非常适合转诊诊所的环境，但不适合艾德的时间紧迫的环境，其中疾病严重程度的高指数需要有效的分诊，而不是诊断的确定性。 我们假设：（a）在艾德中，头晕患者的潜在严重误诊是不常见的，但并不罕见，可能是由于过度依赖症状质量的诊断重要性;（B）一种新的“分诊”诊断方法将减少误诊，并改善头晕诊断方法的“体外”计算机模型的结果;以及（c）基于这种方法的临床决策支持系统将减少在模拟患者条件下的误诊。 为了验证我们的假设，我们设计了三个特定的目标：（1）测量艾德中头晕患者的频率，潜在的严重程度和可能的误诊原因（通过收集每个艾德头晕患者的大量病例数据，并参考多学科专家小组的艾德医生[EP]诊断）;（2）设计一个计算机化的决策模型，以测试一种新的“分诊”诊断方法（通过使用假设的病例情景比较两种诊断方法的“体外”模拟）;以及（3）“试验”基于网络的决策支持系统以减少对模拟艾德眩晕患者的误诊（通过使用随机试验设计，在使用或不使用决策支持系统的情况下，比较基于视频病例的检查上的EP性能）。这项研究的结果将为后续研究眩晕患者减少错误干预的有效性奠定基础。 研究职业奖候选人致力于获得完成该项目所需的临床和研究技能，并作为独立研究者成功开展职业生涯。他获得了他的临床部门和一个大型多学科团队的支持和热情，这将使他能够完成既定目标。这个研究项目和从它派生的研究范式将形成一个职业生涯的核心，致力于研究医疗决策，诊断错误的原因，并防止他们的方法。 性能现场=

EXCEEDTHE SPACE PROVIDED. The goal of our proposed research is to improve diagnosis of patients presenting to the Emergency Department [ED] with dizziness, some of whom are misdiagnosed with potentiallygrave medical consequences. The prevailing diagnostic paradigm for the evaluation of the dizzy patient is based upon a 'pathophysiologic' approach. This approach begins a search for etiology with the assumption that the quality of symptoms (vertigo, presyncope, imbalance, or non-specific dizziness) reflects the underlying pathophysiologic mechanism (vertigo = vestibular, presyncope = cardiovascular, imbalance = neurologic, and non-specific = psychiatric). Although this assumption often holds true, the 'pathophysiologic' approach mandates a thorough etiologic search in each organ system, not only the one suggested by symptom quality. This strategy is well suited to the referral clinic setting where it was developed, but poorly suited to the time-pressured environment of the ED, where the high index of illness severity demands effective triage rather than diagnostic certainty. We hypothesize that (a) potentially serious misdiagnoses of dizzy patients are uncommon but not rare events in the ED and may result from an over-reliance on the diagnostic importance on symptom quality; (b) a novel 'triage' approach to diagnosis would reduce misdiagnoses and improve outcomes in an 'in vitro' computer model of the diagnostic approach to dizziness; and (c) a clinical decision-support system based on this approach would reduce misdiagnoses under simulated patient conditions. To test our hypotheses, we have designed three specific aims to: (1) measure the frequency, potential severity, and possible cause of misdiagnosis of dizzy patients in the ED (by gathering extensive case data on each ED dizzy patient and referencing ED physician [EP] diagnoses against those of a multidisciplinary expert panel); (2) design a computerized decision model to test a new 'triage' approach to diagnosis (by comparing 'in vitro' simulations of the two diagnostic approaches using hypothetical case scenarios); and (3) 'pilot' a web-based decision support system to reduce misdiagnosis of simulated ED dizzy patients (by comparing EP performance on a video-case-based examination with or without the use of the decision support system, using a randomized trial design). Results of this study will form the foundation for subsequent research into the effectiveness of error-reduction interventions among dizzy patients. The research career award candidate has devoted himself to acquiring the clinical and research skills required to complete this project and launch a successful career as an independent investigator. He has garnered the support and enthusiasm of both his clinical department and a large, multidisciplinary team that will enable him to complete the stated objectives. This research project and the research paradigms derived from it will form the nucleus of a career devoted to research in medical decision-making, causes of diagnostic errors, and methods to preventthem. PERFORMANCE SITE ========================================Section End===========================================