Evidence map›Paper›PMID 26157077›Full record

ArticleBMJ (Clinical research ed.)2015

Evaluation of symptom checkers for self diagnosis and triage: audit study.

Hannah L Semigran, Jeffrey A Linder, Courtney Gidengil, Ateev Mehrotra

Abstract readEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 222 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
222citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

222 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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  8. Digital interventions for parents of acutely ill children and their treatment-seeking behaviour: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020
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162 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Hannah L SemigranDepartment of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Jeffrey A LinderDivision of General Medicine and Primary Care, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, USA.
Courtney GidengilDivision of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA RAND Corporation, Boston, MA, USA.
Ateev MehrotraDepartment of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Funding

Antibiotic Prescribing for Acute Respiratory Infections: Impact of Shifts in CareR21AI097759 · NIAID · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI MEHROTRA, ATEEV · 2012 to 2013
$560k
NIAID NIH HHS R21 AI097759-01
6 · The paper itself

Abstract

objectiveTo determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage).

designAudit study.

settingPublicly available, free symptom checkers.

participants23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection).

main outcome measuresFor symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations).

resultsThe 23 symptom checkers provided the correct diagnosis first in 34% (95% confidence interval 31% to 37%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (P<0.001). Performance on appropriate triage advice across the 23 individual symptom checkers ranged from 33% (95% confidence interval 19% to 48%) to 78% (64% to 91%) of standardized patient evaluations.

conclusionsSymptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.

Indexed as

Consumer Health InformationHealth LiteracyHumansInformation Seeking BehaviorMedical AuditPatient Education as TopicQuality of Health CareSelf CareTriage

Identifiers

PMID26157077
PMCPMC4496786

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.