ORIGINAL ARTICLE

ISABEL: a web-based differential diagnostic aid for paediatrics: results from an initial performance evaluation

P Ramnarayan¹, A Tomlinson¹, A Rao², M Coren¹, A Winrow³, J Britto¹

¹ Department of Paediatrics, Imperial College School of Medicine, St Mary’s Hospital, Norfolk Place, London, UK
² Department of Haematology, Chase Farm Hospital, The Ridgeway, Enfield, UK
³ Department of Paediatrics, Kingstone Hospital, Galsworthy Road, Kingston upon Thames, Surrey, UK

Correspondence to:
Correspondence to:
Dr J Britto, Department of Paediatrics, Imperial College School of Medicine, St Mary’s Hospital, Norfolk Place, London W2 1PG, UK;
j.britto{at}ic.ac.uk

Aims: To test the clinical accuracy of a web based differential diagnostic tool (ISABEL) for a set of case histories collected during a two stage evaluation.

Methods: Setting: acute paediatric units in two teaching and two district general hospitals in the southeast of England. Materials: sets of summary clinical features from both stages, and the diagnoses expected for these features from stage I (hypothetical cases provided by participating clinicians in August 2000) and final diagnoses for cases in stage II (children presenting to participating acute paediatric units between October and December 2000). Main outcome measure: presence of the expected or final diagnosis in the ISABEL output list.

Results: A total of 99 hypothetical cases from stage I and 100 real life cases from stage II were included in the study. Cases from stage II covered a range of paediatric specialties (n = 14) and final diagnoses (n = 55). ISABEL displayed the diagnosis expected by the clinician in 90/99 hypothetical cases (91%). In stage II evaluation, ISABEL displayed the final diagnosis in 83/87 real cases (95%).

Conclusion: ISABEL showed acceptable clinical accuracy in producing the final diagnosis for a variety of real as well as hypothetical case scenarios.

Keywords: internet; diagnostic accuracy; decision support; differential diagnosis; medical error

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Atoms

Harvey Marcovitch
Arch. Dis. Child. 2003 88: 369. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Ramnarayan, P., Cronje, N., Brown, R., Negus, R., Coode, B., Moss, P., Hassan, T., Hamer, W., Britto, J. (2007). Validation of a diagnostic reminder system in emergency medicine: a multi-centre study. Emerg. Med. J. 24: 619-624 [Abstract] [Full Text]  
• Fleegler, E. W., Lieu, T. A., Wise, P. H., Muret-Wagstaff, S. (2007). Families' Health-Related Social Problems and Missed Referral Opportunities. Pediatrics 119: e1332-e1341 [Abstract] [Full Text]  
• Ramnarayan, P, Tomlinson, A, Britto, J, Kulkarni, G (2005). Diagnostic decision support in the ED: practical considerations. Emerg. Med. J. 22: 462-462 [Full Text]  
• Ramnarayan, P., Britto, J. (2005). Decision Support Systems: A How-To Guide to Their Evaluation. J Intensive Care Med 20: 176-177  
• Ramnarayan, P., Kapoor, R. R, Coren, M., Nanduri, V., Tomlinson, A. L, Taylor, P. M, Wyatt, J. C, Britto, J. F (2003). Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score. J Am Med Inform Assoc 10: 563-572 [Abstract] [Full Text]  
• Ramnarayan, P., Kapoor, R. R., Coren, M., Nanduri, V., Tomlinson, A. L., Taylor, P. M., Wyatt, J. C., Britto, J. F. (2003). Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score. J. Am. Med. Inform. Assoc. 10: 563-572 [Abstract] [Full Text]  
• Ramnarayan, P, Steel, E., Britto, J. (2003). Sharing patient information electronically throughout NHS: Ability to provide seamless decision support will be key factor. BMJ 327: 623-623 [Full Text]