Graber Mark L, Mathew Ashlei
Medical Service-111, VA Medical Center, Northport, NY 11768, USA.
J Gen Intern Med. 2008 Jan;23 Suppl 1(Suppl 1):37-40. doi: 10.1007/s11606-007-0271-8.
Clinical decision support systems can improve medical diagnosis and reduce diagnostic errors. Older systems, however, were cumbersome to use and had limited success in identifying the correct diagnosis in complicated cases.
To measure the sensitivity and speed of "Isabel" (Isabel Healthcare Inc., USA), a new web-based clinical decision support system designed to suggest the correct diagnosis in complex medical cases involving adults.
We tested 50 consecutive Internal Medicine case records published in the New England Journal of Medicine. We first either manually entered 3 to 6 key clinical findings from the case (recommended approach) or pasted in the entire case history. The investigator entering key words was aware of the correct diagnosis. We then determined how often the correct diagnosis was suggested in the list of 30 differential diagnoses generated by the clinical decision support system. We also evaluated the speed of data entry and results recovery.
The clinical decision support system suggested the correct diagnosis in 48 of 50 cases (96%) with key findings entry, and in 37 of the 50 cases (74%) if the entire case history was pasted in. Pasting took seconds, manual entry less than a minute, and results were provided within 2-3 seconds with either approach.
The Isabel clinical decision support system quickly suggested the correct diagnosis in almost all of these complex cases, particularly with key finding entry. The system performed well in this experimental setting and merits evaluation in more natural settings and clinical practice.
临床决策支持系统可改善医学诊断并减少诊断错误。然而，早期系统使用不便，在复杂病例中确定正确诊断的成功率有限。
评估“伊莎贝尔”（美国伊莎贝尔医疗保健公司）的敏感性和速度，这是一种新型基于网络的临床决策支持系统，旨在为涉及成人的复杂医疗病例提供正确诊断建议。
我们测试了连续发表在《新英格兰医学杂志》上的50份内科病例记录。我们首先手动输入病例中的3至6项关键临床发现（推荐方法），或粘贴整个病例史。输入关键词的研究人员知道正确诊断。然后，我们确定临床决策支持系统生成的30种鉴别诊断列表中正确诊断被建议的频率。我们还评估了数据输入和结果恢复的速度。
通过输入关键发现，临床决策支持系统在50例病例中的48例（96%）中建议了正确诊断；如果粘贴整个病例史，则在50例病例中的37例（74%）中建议了正确诊断。粘贴只需几秒钟，手动输入不到一分钟，两种方法均可在2至3秒内提供结果。
伊莎贝尔临床决策支持系统在几乎所有这些复杂病例中都能快速给出正确诊断建议，尤其是通过输入关键发现时。该系统在本实验环境中表现良好，值得在更自然的环境和临床实践中进行评估。
