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Identifier uch.med.phd//2001bree
Title Συμβολή των διαγνωστικών μεθόδων στη διαφορική διάγνωση του ίκτερου
Alternative Title Objective assessment of the contribution of diagnostic methods in jaundice
Creator Bree, Eelco de
Abstract Background & Aims. Computer-assisted diagnostic systems are not substantially more accurate than the clinician in the differential diagnosis of jaundice, but may help in optimal selection and sequencing of tests. The present study aimed to assess with an electronic diagnostic tool the pattern of ordering tests and the diagnostic contribution and related financial cost of each test in jaundiced patients, in an effort to make the clinician's diagnostic behaviour more efficient and economical. Methods. Clinical and diagnostic test data were prospectively gathered from 1940 jaundiced patients and entered in a Bayesian diagnostic program. The cases were classified into 19 disease categories causing jaundice. The ordering sequence, reasons of ordering the tests and their results on working diagnosis and treatment were recorded. The test results were added to the existing diagnostic evidence and the program calculated the diagnostic contribution of each test. Results. A total of 9251 diagnostic tests were ordered, which delivered approximately 50000 data. An average number of 4.77 diagnostic tests were used to establish the correct diagnosis. Quantitative assessment of the diagnostic contribution of each test was calculated for each disease category. Cost-effective analysis was performed in order to assess more efficient use of diagnostic tools. Theoretically, the cause of jaundice might be detected by the use of three tests in most of the cases. The doctor's diagnostic accuracy using only clinical data was 73%. The computed diagnostic accuracy, using Bayes' values for clinical data and diagnostic test results, was for the entire group 84%. Conclusions. It is possible to determine objectively the diagnostic contribution of each test in establishing the diagnosis. The observed physician's behaviour in ordering the various diagnostic tests might be improved with regard to its efficacy and its cost-effectiveness profile.
Issue date 2001-00-01
Date available 2001-02-05
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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