The acute abdomen: the role of computer-assisted diagnosis.
CAD has been used in over 20,000 patients in an Accident and Emergency Department. Structured documentation has replaced normal case notes and a patient record is created which includes investigations and management. A copy of the documentation acts as an immediate communication to the general practitioner. The information is held on a computer and is readily accessed to produce feedback and to allow audit of any number of parameters. The results show that an improvement in diagnostic accuracy and a reduction in admissions and unnecessary laparotomies continues over 15 years. Problems have occurred; some are inherent to the system and some have been minimized as a result of a series of studies. The savings in terms of finance and facilities are considerable and the cost is small in comparison as the programs are available and the cost of hardware has diminished. It is concluded that documentation is essential. This allows the more accurate collection of information, permits analysis, acts as a method of communication and creates a detailed patient record. The use of this part of the CADA system produces a considerable improvement in the parameters used to assess satisfactory patient management. The computer diagnostic program produces a higher level of diagnostic accuracy than that obtained by doctors who are not using the system. It does not normally exceed the accuracy of the doctors who are using the structured documentation and entering the information into the computer. Other mathematical models might lead to an improvement, particularly if they were based on the diagnostic process used by a senior clinician. The method of entry of information could be facilitated by modern technology, including light pens or word sensitive computers. This would reduce the time required for completion of the documents. A number of possible improvements in the CADA system are reported and some have been studied in detail with little evidence of significant change. The computer part of the system has an educational value and presents a stimulating challenge to the junior hospital staff seeing the patient for the first time in the Accident and Emergency Department. Rapid feedback is possible and advantageous. Possibly the greatest value of the computer is in the analysis of the value of clinical features in diagnosis, which has not been easy in the past. It has also allowed precise assessment of the value of investigations in the diagnosis of patients with a suspected disease, which leads to more appropriate management and the saving of facilities.(ABSTRACT TRUNCATED AT 400 WORDS)
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Gunn
D000006:Abdomen, Acute / Q000175:diagnosis* / Q000453:epidemiology; D016208:Databases, Factual; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D008485:Medical Audit; D008487:Medical History Taking; D012606:Scotland / Q000453:epidemiology; D012680:Sensitivity and Specificity