Evidence map›Paper›PMID 26254875›Full record

ArticleInternational journal of medical informatics2015

Computer versus physician identification of gastrointestinal alarm features.

Christopher V Almario, William D Chey, Sentia Iriana, Francis Dailey, Karen Robbins, Anish V Patel, Mark Reid, Cynthia Whitman, Garth Fuller, Roger Bolus and 12 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of medical informatics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 1 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

13 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Christopher V AlmarioDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
William D CheyDivision of Gastroenterology, University of Michigan, Ann Arbor, MI, USA.
Sentia IrianaDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Francis DaileyDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Karen RobbinsDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Anish V PatelDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Mark ReidDivision of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Cynthia WhitmanDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Garth FullerDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Roger BolusCedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Buddy DennisUCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA, USA.
Rey EncarnacionUCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA, USA.
Bibiana MartinezDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Jennifer SoaresDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Rushaba ModiDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA.
Nikhil AgarwalDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA.
Aaron LeeDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Scott KubomotoDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Gobind SharmaDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Sally BolusCedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
Lin ChangDivision of Digestive Diseases, UCLA, Los Angeles, CA, USA.
Brennan M R SpiegelDivision of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Electronic address: Brennan.Spiegel@cshs.org.

Funding

University of Michigan Center for Gastrointestinal ResearchP30DK034933 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI WILEY, JOHN W · 1986 to 2021
$22.5M
NIH PROMIS Statistical Coordinating Center(RMI)U01AR052177 · NIAMS · NORTHWESTERN UNIVERSITY AT CHICAGO · PI CELLA, DAVID · 2004 to 2010
$10.6M
GASTROENTEROLOGYT32DK007180 · NIDDK · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI JENSEN, DENNIS MICHAEL · 1986 to 2025
$10.0M
UCLA/RAND HEALTH SERVICES RESEARCH TRAINING PROGRAMT32HS000046 · AHRQ · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI EISENBERG, DANIEL · 1992 to 2024
$8.7M
Development and Initial Validation of PROMIS GI Distress ScaleU01AR057936 · NIAMS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI KHANNA, DINESH, SPIEGEL, BRENNAN · 2009 to 2013
$2.2M
NIAMS NIH HHS AR052177NIAMS NIH HHS U01 AR052177NIAMS NIH HHS U01 AR057936NIAMS NIH HHS U01 AR057936ANIDDK NIH HHS P30 DK034933NIDDK NIH HHS T32 DK007180NIDDK NIH HHS T32DK07180-40
6 · The paper itself

Abstract

objectiveIt is important for clinicians to inquire about "alarm features" as it may identify those at risk for organic disease and who require additional diagnostic workup. We developed a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS) that systematically collects patient gastrointestinal (GI) symptoms and alarm features, and then "translates" the information into a history of present illness (HPI). Our study's objective was to compare the number of alarms documented by physicians during usual care vs. that collected by AEGIS.

methodsWe performed a cross-sectional study with a paired sample design among patients visiting adult GI clinics. Participants first received usual care by their physicians and then completed AEGIS. Each individual thus contributed both a physician-documented and computer-generated HPI. Blinded physician reviewers enumerated the positive alarm features (hematochezia, melena, hematemesis, unintentional weight loss, decreased appetite, and fevers) mentioned in each HPI. We compared the number of documented alarms within patient using the Wilcoxon signed-rank test.

resultsSeventy-five patients had both physician and AEGIS HPIs. AEGIS identified more patients with positive alarm features compared to physicians (53% vs. 27%; p<.001). AEGIS also documented more positive alarms (median 1, interquartile range [IQR] 0-2) vs. physicians (median 0, IQR 0-1; p<.001). Moreover, clinicians documented only 30% of the positive alarms self-reported by patients through AEGIS.

conclusionsPhysicians documented less than one-third of red flags reported by patients through a computer algorithm. These data indicate that physicians may under report alarm features and that computerized "checklists" could complement standard HPIs to bolster clinical care.

Indexed as

AlgorithmsUser-Computer InterfaceCross-Sectional StudiesDecision Support Systems, ClinicalDiagnosis, Computer-AssistedElectronic Health RecordsGastrointestinal DiseasesHumansMedical History TakingMichiganObserver VariationReproducibility of ResultsSensitivity and SpecificitySymptom AssessmentAlarm featuresChecklistsPatient-provider portal

Identifiers

PMID26254875
PMCPMC4762475

What OpenQuestion holds

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Registered trials

None linked

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.