Wallace William, Chan Calvin, Chidambaram Swathikan, Hanna Lydia, Acharya Amish, Daniels Elisabeth, Normahani Pasha, Matin Rubeta N, Markar Sheraz R, Sounderajah Viknesh, Liu Xiaoxuan, Darzi Ara
Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom.
Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, United Kingdom.
PLOS Digit Health. 2024 Aug 5;3(8):e0000558. doi: 10.1371/journal.pdig.0000558. eCollection 2024 Aug.
Online symptom checkers are increasingly popular health technologies that enable patients to input their symptoms to produce diagnoses and triage advice. However, there is concern regarding the performance and safety of symptom checkers in diagnosing and triaging patients with life-threatening conditions. This retrospective cross-sectional study aimed to evaluate and compare commercially available symptom checkers for performance in diagnosing and triaging myocardial infarctions (MI). Symptoms and biodata of MI patients were inputted into 8 symptom checkers identified through a systematic search. Anonymised clinical data of 100 consecutive MI patients were collected from a tertiary coronary intervention centre between 1st January 2020 to 31st December 2020. Outcomes included (1) diagnostic sensitivity as defined by symptom checkers outputting MI as the primary diagnosis (D1), or one of the top three (D3), or top five diagnoses (D5); and (2) triage sensitivity as defined by symptom checkers outputting urgent treatment recommendations. Overall D1 sensitivity was 48±31% and varied between symptom checkers (range: 6-85%). Overall D3 and D5 sensitivity were 73±20% (34-92%) and 79±14% (63-94%), respectively. Overall triage sensitivity was 83±13% (55-91%). 24±16% of atypical cases had a correct D1 though for female atypical cases D1 sensitivity was only 10%. Atypical MI D3 and D5 sensitivity were 44±21% and 48±24% respectively and were significantly lower than typical MI cases (p<0.01). Atypical MI triage sensitivity was significantly lower than typical cases (53±20% versus 84±15%, p<0.01). Female atypical cases had significantly lower diagnostic and triage sensitivity than typical female MI cases (p<0.01).Given the severity of the pathology, the diagnostic performance of symptom checkers for correctly diagnosing an MI is concerningly low. Moreover, there is considerable inter-symptom checker performance variation. Patients presenting with atypical symptoms were under-diagnosed and under-triaged, especially if female. This study highlights the need for improved clinical performance, equity and transparency associated with these technologies.
在线症状检查器是越来越受欢迎的健康技术，它使患者能够输入自身症状以获得诊断结果和分诊建议。然而，人们担心症状检查器在诊断和分诊危及生命的疾病患者时的性能和安全性。这项回顾性横断面研究旨在评估和比较市面上可买到的症状检查器在诊断和分诊心肌梗死（MI）方面的性能。通过系统检索确定了8种症状检查器，并将MI患者的症状和生物数据输入其中。从一家三级冠状动脉介入中心收集了2020年1月1日至2020年12月31日期间连续100例MI患者的匿名临床数据。结果包括：（1）诊断敏感性，定义为症状检查器将MI作为主要诊断输出（D1），或作为前三项诊断之一（D3），或作为前五项诊断之一（D5）；（2）分诊敏感性，定义为症状检查器输出紧急治疗建议。总体D1敏感性为48±31%，不同症状检查器之间有所差异（范围：6 - 85%）。总体D3和D5敏感性分别为73±20%（34 - 92%）和79±14%（63 - 94%）。总体分诊敏感性为83±13%（55 - 91%）。24±16%的非典型病例有正确的D1诊断，不过女性非典型病例的D(1)敏感性仅为10%。非典型MI的D3和D5敏感性分别为44±21%和48±24%，显著低于典型MI病例（p<0.01）。非典型MI的分诊敏感性显著低于典型病例（53±20%对84±15%，p<0.01）。女性非典型病例的诊断和分诊敏感性显著低于典型女性MI病例（p<0.01）。鉴于该病症的严重性，症状检查器正确诊断MI的诊断性能低得令人担忧。此外，不同症状检查器的性能存在相当大的差异。出现非典型症状的患者诊断不足且分诊不足，女性患者尤其如此。这项研究凸显了改善这些技术的临床性能、公平性和透明度的必要性。
