Evidence map›Paper›PMID 27964737›Full record

ArticlePediatric rheumatology online journal2016

Evidence-based decision support for pediatric rheumatology reduces diagnostic errors.

Michael M Segal, Balu Athreya, Mary Beth F Son, Irit Tirosh, Jonathan S Hausmann, Elizabeth Y N Ang, David Zurakowski, Lynn K Feldman, Robert P Sundel

3 registry-linked trialsOpen access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Pediatric rheumatology online journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
0.6field-weighted citation impact, top 25% of its field
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.

NCT02205086 naunknown statusnot on this map

Empowering Physicians With Evidence-Based Decision Support for Pediatric Rheumatology

TypeinterventionalSponsorSimulConsult, Inc.Ran2014 to 2014Enrolled30ConditionsRheumatologyArmsDiagnosis
NCT03501667 naunknown statusnot on this mapstarted 2020, after this paper: background citation

Boston Children's Hospital

TypeinterventionalSponsorBoston Children's HospitalRan2020 to 2020Enrolled900ConditionsPediatric Rheumatological Condition (i.e., Arthritis, SLE, Kawasaki's Disaese)ArmsUse of decision support tool, Use of UpToDate
NCT04856956 naunknown statusnot on this mapstarted 2021, after this paper: background citation

Testing Pediatric Rheumatology Diagnostic Decision Support in Clinical Use

TypeinterventionalSponsorPhenoSolve, LLCRan2021 to 2023Enrolled15ConditionsDiagnostic Skills for Rheumatologic ConditionsArmsDiagnostic decision support software
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
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

9 authors at 5 institutions in 3 countries.

Michael M SegalSimulConsult, Chestnut Hill, MA, USA.
Balu AthreyaDuPont Hospital for Children, Wilmington, DE and Thomas Jefferson University, Philadelphia, PA, USA.
Mary Beth F SonBoston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
Irit TiroshEdmond and Lily Safra Children's Hospital, Tel-Hashomer, Ramat-Gan, Israel and Tel Aviv University, Tel Aviv, Israel.
Jonathan S HausmannBoston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
Elizabeth Y N AngNational Univesity Hospital, Singapore, Singapore.
David ZurakowskiBoston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
Lynn K FeldmanSimulConsult, Chestnut Hill, MA, USA.
Robert P SundelBoston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. robert.sundel@childrens.harvard.edu.
Boston Children's Hospital · USSimulConsult · USDuPont (United States) · USNational University Hospital · SGTel Aviv University · IL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists.

methodsUsing vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases (averaging 22 findings per disease). Rheumatology content in the database was developed using both primary references and textbooks. The frequency, timing, age of onset and age of disappearance of findings, as well as their incidence, treatability, and heritability were taken into account in order to guide diagnostic decision making. These capabilities allowed key information such as pertinent negatives and evolution over time to be used in the computations. Efficacy was measured by comparing whether the correct condition was included in the differential diagnosis generated by clinicians before using the software ("unaided"), versus after use of the DDSS ("aided").

resultsThe 26 clinicians demonstrated a significant reduction in diagnostic errors following introduction of the software, from 28% errors while unaided to 15% using decision support (p < 0.0001). Improvement was greatest for emergency medicine physicians (p = 0.013) and clinicians in practice for less than 10 years (p = 0.012). This error reduction occurred despite the fact that testers employed an "open book" approach to generate their initial lists of potential diagnoses, spending an average of 8.6 min using printed and electronic sources of medical information before using the diagnostic software.

conclusionsThese findings suggest that decision support can reduce diagnostic errors and improve use of relevant information by generalists. Such assistance could potentially help relieve the shortage of experts in pediatric rheumatology and similarly underserved specialties by improving generalists' ability to evaluate and diagnose patients presenting with musculoskeletal complaints.

trial registrationClinicalTrials.gov ID: NCT02205086.

Indexed as

Decision Support TechniquesEvidence-Based MedicineSoftwareChildDiagnostic ErrorsHumansRheumatic DiseasesComputer softwareDecision supportDiagnosisDiagnostic errorsMedical informaticsPediatric rheumatology

Identifiers

PMID27964737
PMCPMC5155385
OpenAlexW2567422435

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

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.