BMC Med Inform Decis Mak - Is increasing complexity of algorithms the price for higher accuracy? virtual comparison of three algorithms for tertiary level management of chronic cough in people living with HIV in a low-income country.

Tópicos

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Resumo

CKGROUND: The algorithmic approach to guidelines has been introduced and promoted on a large scale since the 1970s. This study aims at comparing the performance of three algorithms for the management of chronic cough in patients with HIV infection, and at reassessing the current position of algorithmic guidelines in clinical decision making through an analysis of accuracy, harm and complexity.METHODS: Data were collected at the University Hospital of Kigali (CHUK) in a total of 201 HIV-positive hospitalised patients with chronic cough. We simulated management of each patient following the three algorithms. The first was locally tailored by clinicians from CHUK, the second and third were drawn from publications by M?decins sans Fronti?res (MSF) and the World Health Organisation (WHO). Semantic analysis techniques known as Clinical Algorithm Nosology were used to compare them in terms of complexity and similarity. For each of them, we assessed the sensitivity, delay to diagnosis and hypothetical harm of false positives and false negatives.RESULTS: The principal diagnoses were tuberculosis (21%) and pneumocystosis (19%). Sensitivity, representing the proportion of correct diagnoses made by each algorithm, was 95.7%, 88% and 70% for CHUK, MSF and WHO, respectively. Mean time to appropriate management was 1.86 days for CHUK and 3.46 for the MSF algorithm. The CHUK algorithm was the most complex, followed by MSF and WHO. Total harm was by far the highest for the WHO algorithm, followed by MSF and CHUK.CONCLUSIONS: This study confirms our hypothesis that sensitivity and patient safety (i.e. less expected harm) are proportional to the complexity of algorithms, though increased complexity may make them difficult to use in practice.

Resumo Limpo

ckground algorithm approach guidelin introduc promot larg scale sinc s studi aim compar perform three algorithm manag chronic cough patient hiv infect reassess current posit algorithm guidelin clinic decis make analysi accuraci harm complexitymethod data collect univers hospit kigali chuk total hivposit hospitalis patient chronic cough simul manag patient follow three algorithm first local tailor clinician chuk second third drawn public mdecin san frontir msf world health organis semant analysi techniqu known clinic algorithm nosolog use compar term complex similar assess sensit delay diagnosi hypothet harm fals posit fals negativesresult princip diagnos tuberculosi pneumocystosi sensit repres proport correct diagnos made algorithm chuk msf respect mean time appropri manag day chuk msf algorithm chuk algorithm complex follow msf total harm far highest algorithm follow msf chukconclus studi confirm hypothesi sensit patient safeti ie less expect harm proport complex algorithm though increas complex may make difficult use practic

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