title: Diagnostic probability function for acute coronary heart disease garnered from experts' tacit knowledge.
abstract: OBJECTIVE
  Knowing about a diagnostic probability requires general knowledge about the way in which the probability depends on the diagnostic indicators involved in the specification of the case at issue. Diagnostic probability functions (DPFs) are generally unavailable at present. Our objective was to illustrate how diagnostic experts' case-specific tacit knowledge about diagnostic probabilities could be garnered in the form of DPFs.
  
  
  METHODS
  Focusing on diagnosis of acute coronary heart disease (ACHD), we presented doctors with extensive experience in hospitals' emergency departments a set of hypothetical cases specified in terms of an inclusive set of diagnostic indicators. We translated the medians of these experts' case-specific probabilities into a logistic DPF for ACHD.
  
  
  RESULTS
  The principal result was the experts' typical diagnostic probability for ACHD as a joint function of the set of diagnostic indicators. A related result of note was the finding that the experts' probabilities in any given case had a surprising degree of variability.
  
  
  CONCLUSIONS
  Garnering diagnostic experts' case-specific tacit knowledge about diagnostic probabilities in the form of DPFs is feasible to accomplish. Thus, once the methodology of this type of work has been "perfected," practice-guiding diagnostic expert systems can be developed.
authors.affiliation: Horten Centre for Patient-Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland. Electronic address: johann.steurer@usz.ch.
authors.forename: Johann
authors.initials: J
authors.lastname: Steurer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.forename: Olli S
authors.initials: OS
authors.lastname: Miettinen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000789:Angina, Unstable / Q000175:diagnosis*; D002637:Chest Pain / Q000209:etiology; D002983:Clinical Competence; D004417:Dyspnea / Q000209:etiology; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019359:Knowledge; D008297:Male; D008505:Medical Staff, Hospital; D009203:Myocardial Infarction / Q000175:diagnosis*; D011336:Probability
keywords: Acute coronary heart disease; Chest pain; Diagnosis; Diagnostic probability function; Experts; Tacit knowledge