Ohmann C, Thon K, Stöltzing H, Yang Q, Lorenz W
Med Decis Making. 1986 Oct-Dec;6(4):208-15. doi: 10.1177/0272989X8600600405.
Various strategies can be used in the diagnosis of upper gastrointestinal tract bleeding. This study investigates the relevance of anamnestic and clinical findings for the diagnosis of the bleeding source. The authors introduced a computer-aided diagnostic system using Bayes' theorem and compared it with clinicians' predictions using anamnestic and clinical findings only. There was no difference in the overall accuracy rates, but a difference was observed in the diagnostic behaviors of the two "systems." In addition, the discriminatory ability of the computer-aided system, the sharpness of the predictions obtained, and the reliability of the posterior probabilities were analyzed. It is concluded that the clinician and the computer-aided system are not able to discriminate well between the disease categories. Derived classification matrices and probability-based measures show the reasons for the inadequacy of diagnostic information obtainable from the clinical history and physical findings.
可采用多种策略诊断上消化道出血。本研究调查了既往史和临床检查结果对出血源诊断的相关性。作者引入了一种使用贝叶斯定理的计算机辅助诊断系统，并将其与仅使用既往史和临床检查结果的临床医生预测进行比较。总体准确率没有差异，但观察到两种“系统”的诊断行为存在差异。此外，还分析了计算机辅助系统的鉴别能力、所得预测的清晰度以及后验概率的可靠性。得出的结论是，临床医生和计算机辅助系统无法很好地区分疾病类别。推导的分类矩阵和基于概率的测量结果显示了从临床病史和体格检查中获取的诊断信息不足的原因。
