Trial reportBMJ quality & safety2022
Should electronic differential diagnosis support be used early or late in the diagnostic process? A multicentre experimental study of Isabel.
Trial report in BMJ quality & safety, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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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
22 citing papers in PubMed.
- Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Improving decision accuracy using a clinical decision support system for medical students during history-taking: a randomized clinical trial.BMC medical education · 2023Trial
- Nurse Practitioner Students' Perceptions of an Artificial Intelligence Differential Diagnosis Tool: A Pilot Study.Journal of clinical nursing · 2026Article
- Feasibility of Pediatric Diagnostic Quality Measurement in All United States Hospitals.Annals of emergency medicine · 2026Article
- AI in the Hot Seat: Head-to-Head Comparison of Large Language Models and Cardiologists in Emergency Scenarios.Medical sciences (Basel, Switzerland) · 2026Article
- Cracking the code: a head-to-head comparison of expert clinicians and artificial intelligence in diagnosing rare diseases.Orphanet journal of rare diseases · 2025Article
- Computerized diagnostic decision support systems-Isabel Pro versus ChatGPT-4 part II.JAMIA open · 2025Article
- Transforming clinical reasoning-the role of AI in supporting human cognitive limitations.Frontiers in digital health · 2025Review
- Large Language Models in the Diagnosis of Hand and Peripheral Nerve Injuries: An Evaluation of ChatGPT and the Isabel Differential Diagnosis Generator.Journal of hand surgery global online · 2024Article
- Comparative Study to Evaluate the Accuracy of Differential Diagnosis Lists Generated by Gemini Advanced, Gemini, and Bard for a Case Report Series Analysis: Cross-Sectional Study.JMIR medical informatics · 2024Article
- Diagnostic accuracy of GPT-4 on common clinical scenarios and challenging cases.Learning health systems · 2024Article
- Longitudinal Changes in Diagnostic Accuracy of a Differential Diagnosis List Developed by an AI-Based Symptom Checker: Retrospective Observational Study.JMIR formative research · 2024Article
- Review
- Clinical Decision Support Requirements for Ventricular Tachycardia Diagnosis Within the Frameworks of Knowledge and Practice: Survey Study.JMIR human factors · 2024Article
- Medico-legal risk of infectious disease physicians in Canada: A retrospective review.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2024Article
- The Accuracy and Potential Racial and Ethnic Biases of GPT-4 in the Diagnosis and Triage of Health Conditions: Evaluation Study.JMIR medical education · 2023Article
- Effects of Combinational Use of Additional Differential Diagnostic Generators on the Diagnostic Accuracy of the Differential Diagnosis List Developed by an Artificial Intelligence-Driven Automated History-Taking System: Pilot Cross-Sectional Study.JMIR formative research · 2023Article
- Diagnostic Delays in Sepsis: Lessons Learned From a Retrospective Study of Canadian Medico-Legal Claims.Critical care explorations · 2023Article
- Influences of early diagnostic suggestions on clinical reasoning.Cognitive research: principles and implications · 2022Article
- Electronic Diagnostic Support in Emergency Physician Triage: Qualitative Study With Thematic Analysis of Interviews.JMIR human factors · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDiagnostic errors unfortunately remain common. Electronic differential diagnostic support (EDS) systems may help, but it is unclear when and how they ought to be integrated into the diagnostic process.
objectiveTo explore how much EDS improves diagnostic accuracy, and whether EDS should be used early or late in the diagnostic process.
setting6 Canadian medical schools. A volunteer sample of 67 medical students, 62 residents in internal medicine or emergency medicine, and 61 practising internists or emergency medicine physicians were recruited in May through June 2020.
interventionParticipants were randomised to make use of EDS either early (after the chief complaint) or late (after the complete history and physical is available) in the diagnostic process while solving each of 16 written cases. For each case, we measured the number of diagnoses proposed in the differential diagnosis and how often the correct diagnosis was present within the differential.
resultsEDS increased the number of diagnostic hypotheses by 2.32 (95% CI 2.10 to 2.49) when used early in the process and 0.89 (95% CI 0.69 to 1.10) when used late in the process (both p<0.001). Both early and late use of EDS increased the likelihood of the correct diagnosis being present in the differential (7% and 8%, respectively, both p<0.001). Whereas early use increased the number of diagnostic hypotheses (most notably for students and residents), late use increased the likelihood of the correct diagnosis being present in the differential regardless of one's experience level. CONCLUSIONS AND RELEVANCE: EDS increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis appearing in the differential, and these effects persisted irrespective of whether EDS was used early or late in the diagnostic process.
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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.