症状检查器应用程序的分诊准确性：5 年随访评估。
Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation.
机构信息
Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Cognitive Psychology and Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany.
出版信息
J Med Internet Res. 2022 May 10;24(5):e31810. doi: 10.2196/31810.
BACKGROUND
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.
OBJECTIVE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
背景
症状检查器是一种数字工具，可帮助非专业人员自行评估其医疗投诉的紧迫性和潜在原因。它们被广泛使用，但患者和医疗保健专业人员都对其准确性表示担忧，尤其是在准确性方面。一项 2015 年的具有里程碑意义的研究使用病例摘要证明了这些担忧，表明症状检查器在分诊评估中经常出错。
目的
本研究旨在重新审视具有里程碑意义的索引研究，以调查自 2015 年以来症状检查器的功能是否以及如何发展，以及它们目前与非专业人员的独立分诊评估相比如何。
方法
在 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。我们使用与索引研究相同的 45 个病例摘要评估了这些应用程序。使用描述性统计，我们将我们的发现与索引研究和公众可获得的有关非专业人员分诊能力的数据进行了比较。
结果
我们检索到 22 个提供分诊建议的症状检查器。2020 年的中位分诊准确率为 55.8%（IQR 15.1%），与 2015 年的 59.1%（IQR 15.5%）相近。2020 年的应用程序风险规避程度较低（优势比 1.11：1，过度治疗错误与漏诊错误的比值），比 2015 年的应用程序（优势比 2.82：1）错过> 40%的紧急情况。很少有应用程序在决定是否需要紧急护理或目前是否不需要医疗护理方面优于非专业人员。没有应用程序在这两个决策上都优于非专业人员。
结论
在过去的 5 年中，症状检查器的分诊性能平均没有提高。在 2 个用例中，分诊性能有所下降（关于何时需要紧急护理以及何时不需要医疗护理的建议）。然而，症状检查器的分诊能力在样本内差异很大。是否从症状检查器寻求建议取决于所选择的应用程序以及要回答的具体问题。未来的研究应开发资源（例如，病例摘要存储库），以独立且持续地审核症状检查器的功能，并提供有关何时以及向谁推荐的指导。
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