Fraser H S, Long W J, Naimi S
Clinical Decision Making Group, MIT Laboratory for Computer Science, Cambridge, MA 02139, USA.
Proc AMIA Symp. 1998:622-6.
We describe a prospective clinical evaluation of a computer program to assist with the diagnosis of heart disease. The Heart Disease Program (HDP) is a large diagnostic program covering most areas of heart disease and some related areas of general medicine. The program's output is a set of differential diagnoses with explanations and it can be deployed in a clinical setting using a web interface. A framework for assessing the complex diagnostic summaries generated by the HDP was developed and the program's diagnostic accuracy in a clinical setting was assessed. The diagnoses used for comparison came from the physician entering the case, a "gold standard" assigned by review of patient charts and investigations, and the opinions of expert cardiologists. The data collection, methods of comparison, example analyses and results on 114 cases are presented here. The HDP had a significantly higher sensitivity for both the gold standard (60%) and the cardiologist's diagnoses (58%) than the physicians did (39%, 34%). These findings were consistent in the 2 collection cohorts and for the more serious diagnoses alone. The significance of these findings and the many challenges in comparing these different diagnoses and minimizing bias are discussed.
我们描述了一项用于辅助心脏病诊断的计算机程序的前瞻性临床评估。心脏病程序（HDP）是一个大型诊断程序，涵盖了心脏病的大多数领域以及普通医学的一些相关领域。该程序的输出是一组带有解释的鉴别诊断，并且可以通过网络界面在临床环境中部署。开发了一个用于评估HDP生成的复杂诊断总结的框架，并评估了该程序在临床环境中的诊断准确性。用于比较的诊断来自输入病例的医生、通过查阅患者病历和检查确定的“金标准”以及心脏病专家的意见。本文介绍了114例病例的数据收集、比较方法、示例分析和结果。与医生相比，HDP对金标准诊断（60%）和心脏病专家诊断（58%）的敏感性显著更高（医生分别为39%和34%）。这些发现在两个收集队列中以及仅针对更严重诊断时都是一致的。讨论了这些发现的意义以及在比较这些不同诊断和最小化偏差方面存在的诸多挑战。
