ArticleAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2020
Diagnostic Performance of Emergency Physician Gestalt for Predicting Acute Appendicitis in Patients Age 5 to 20 Years.
Article in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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.
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.
Who cites it
9 citing papers in PubMed, 19 citations in OpenAlex.
- Validation of 2 Syncope Risk Scores and Comparison With Physician Risk Estimation.JAMA network open · 2026Observational
- Suspected Pediatric Appendicitis Management in the Emergency Department: A Prospective Observational Study in an Australian Pediatric Emergency Department.Pediatric emergency care · 2026Observational
- Physician Gestalt for Anemia Detection in the Emergency Department: A Prospective Study.The western journal of emergency medicine · 2026Observational
- Clinical Gestalt to Predict Bacterial Infection and Mortality in Emergency Department Patients: A Prospective Observational Study.Journal of general internal medicine · 2026Observational
- A Quality Improvement Initiative to Decrease Hospital Admission for Skin and Soft Tissue Infections From an Observation Unit.Journal of the American College of Emergency Physicians open · 2025Article
- Article
- Diagnostic accuracy of doctors at the emergency department and radiologists in differentiating between complicated and uncomplicated acute appendicitis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
- Prediction of patient disposition: comparison of computer and human approaches and a proposed synthesis.Journal of the American Medical Informatics Association : JAMIA · 2021Observational
- Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019.Annals of emergency medicine · 2020Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 8 institutions in 1 country.
Funding
Abstract
objectivesPediatric appendicitis remains a challenging diagnosis in the emergency department (ED). Available risk prediction algorithms may contribute to excessive ED imaging studies. Incorporation of physician gestalt assessment could help refine predictive tools and improve diagnostic imaging decisions.
methodsThis study was a subanalysis of a parent study that prospectively enrolled patients ages 5 to 20.9 years with a chief complaint of abdominal pain presenting to 11 community EDs within an integrated delivery system between October 1, 2016, and September 30, 2018. Prior to diagnostic imaging, attending emergency physicians enrolled patients with ≤5 days of right-sided or diffuse abdominal pain using a Web-based application embedded in the electronic health record. Predicted risk (gestalt) of acute appendicitis was prospectively entered using a sliding scale from 1% to 100%. As a planned secondary analysis, we assessed the performance of gestalt via c-statistics of receiver operating characteristic (ROC) curves; tested associations between gestalt performance and patient, physician, and facility characteristics; and examined clinical characteristics affecting gestalt estimates.
resultsOf 3,426 patients, 334 (9.8%) had confirmed appendicitis. Physician gestalt had excellent ROC curve characteristics (c-statistic = 0.83, 95% confidence interval = 0.81 to 0.85), performing particularly well in the low-risk strata (appendicitis rate = 1.1% in gestalt 1%-10% range, negative predictive value of 98.9% for appendicitis diagnosis). Physicians with ≥5 years since medical school graduation demonstrated improved gestalt performance over those with less experience (p = 0.007). All clinical characteristics tested, except pain <24 hours, were significantly associated with physician gestalt value (p < 0.05).
conclusionPhysician gestalt for acute appendicitis diagnosis performed well, especially in low-risk patients and when employed by experienced physicians.
Indexed as
Identifiers
What OpenQuestion holds
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.