Randomized clinical trial at Geneva University Hospitals (HUG) on DIAANA software
Differential Diagnosis Assessment in Ambulatory Care with an Automated Medical History-Taking Device: A Pilot Randomized Study
Adrien jean-Pierre Schwitzguebel, Clarisse Jeckelmann, Roberto Gavinio, Cécile Levallois, Charles Benaïm, Hervé Spechbach
In studies performed in the USA on medical errors in primary care medicine, diagnostic errors are the most common and the most expensive, as well as the cause of most malpractice claims . A prevalence of diagnostic errors in outpatient care of at least 5% has been reported. Despite their importance, diagnostic errors are underemphasized and under-identified and the development of novel strategies to improve the accuracy of the initial diagnosis should be a priority.
Background: Automated medical history-taking devices (AMHTD) are emerging tools with the potential to increase the quality of medical consultations by providing physicians with an exhaustive, high-quality, standardized anamnesis and differential diagnosis (DD).
This study aims to assess the effectiveness of an AMHTD to obtain an accurate DD in an outpatient service.
We conducted a pilot, randomized controlled trial including 59 patients presenting to an emergency outpatient unit and suffering from various conditions affecting the limbs, the back and the chest wall. Resident physicians were randomized into two groups, one assisted by the AMHTD and one without access to the device. For each patient, physicians were asked to establish an exhaustive DD based on the anamnesis and clinical examination. In the intervention group, residents read the AMHTD report before performing the anamnesis. In both groups, the senior physician had to establish a DD, considered as the gold standard, independent of the resident’s opinion and the AMHTD report.
Physicians in the intervention group (n=29) had more years of clinical practice compared to the control group (n=30) (mean: 4.3 ± 2 vs. 5.5 ± 2, respectively; P=.03). There were also 16.1% more DDs in the intervention group (mean: 75.3 ± 26% vs. 59.2 ± 31%, 2 respectively; P=.01). Subgroup analysis showed a between-group difference of 3.3% for low complexity cases (1-2 DDs possible) in favor of the AHMTD, 31.1% for intermediate complexity (3 DDs), and 23.7% for high complexity (4-5 DDs). The AMHTD was able to determine 72.6 ± 30% of the correct DDs. Patient satisfaction was good (4.3/5) and 26/29 patients (90%) estimated being able to accurately describe their symptomatology. In eight of 29 cases (28%), the residents considered that the AMHTD helped DD establishment.
The AMHTD allowed physicians to make more accurate DD, particularly in complex cases where the diagnosis is not evident. This could be explained not only by the ability of the AMHTD to make the right diagnoses, but also by the exhaustive anamnesis provided.