基于指南的哮喘决策支持系统的有效性：第二步
2010/02/23
目的：之前我们介绍过一种电脑化的哮喘决策支持系统，并以肺科专家意见作为金标准，检测了其在鉴别哮喘严重程度方面的准确性。电脑化的决策支持系统在鉴别哮喘严重程度上有可能超过肺科专家。该研究旨在评价电脑化决策系统和肺科专家诊断哮喘严重程度的准确性是否优于2007年全球哮喘防治指南。
设计：由住院医师设计100个哮喘病例，并根据2007年全球哮喘防治指南对其进行分类。上述病例被认为是金标准。然后将上述案例输入电脑化的哮喘决策支持系统，同时将这些病例发给10个肺科专家。计算电脑化决策支持系统和肺科专家在诊断哮喘上的敏感性、特异性和一致性。
结果：电脑化的决策支持系统其敏感性和特异性均为100％。专家的敏感性为94.2％，特异性为70％。电脑化决策支持系统与金标准的一致性尤佳（Kappa = 1.00）。肺科专家和金标准之间的Kappa值为0.672。
结论：根据2007年全球哮喘防治指南，电脑化的决策支持系统在诊断哮喘严重程度的准确性方面优于肺科专家。
（林江涛 审校）
J Asthma. 2009 Nov;46(9):933-935.
Validating a guidelines-based asthma decision support system: step two.
Stern T, Hunt J, Norton HJ.
PURPOSE: Previously we described a computerized asthma decision support system and measured its accuracy in classifying asthma severity using pulmonologists as the gold standard. It is possible that the computerized decision support system may outperform pulmonologists in classifying asthma severity. The purpose of this study was to determine whether the computerized decision support system or pulmonologists have better accuracy with the 2007 edition of the Global Initiative for Asthma guidelines in classifying asthma severity. DESIGN. One hundred asthma case scenarios were developed by a medical resident and classified according to the 2007 Global Initiative for Asthma guidelines. These case scenarios were deemed the gold standard. These case scenarios were then entered into a computerized asthma decision support system and also presented to a group of 10 practicing pulmonologists. Sensitivity, specificity, and agreement were calculated for the computerized decision support system and the pulmonologists.
RESULTS: The sensitivity and specificity of the computerized decision support system was 100%. The sensitivity of the pulmonologist was 94.2% and the specificity was 70.0%. Agreement between the computerized decision support system and the gold standard was perfect with a Kappa = 1.00. The Kappa between the pulmonologists and the gold standard was equal to 0.672.
CONCLUSION: The computerized decision support system outperformed pulmonologists in the task of assigning asthma severity according to the 2007 Global Initiative for Asthma guidelines.
J Asthma. 2009 Nov;46(9):933-5.
设计：由住院医师设计100个哮喘病例，并根据2007年全球哮喘防治指南对其进行分类。上述病例被认为是金标准。然后将上述案例输入电脑化的哮喘决策支持系统，同时将这些病例发给10个肺科专家。计算电脑化决策支持系统和肺科专家在诊断哮喘上的敏感性、特异性和一致性。
结果：电脑化的决策支持系统其敏感性和特异性均为100％。专家的敏感性为94.2％，特异性为70％。电脑化决策支持系统与金标准的一致性尤佳（Kappa = 1.00）。肺科专家和金标准之间的Kappa值为0.672。
结论：根据2007年全球哮喘防治指南，电脑化的决策支持系统在诊断哮喘严重程度的准确性方面优于肺科专家。
（林江涛 审校）
J Asthma. 2009 Nov;46(9):933-935.
Validating a guidelines-based asthma decision support system: step two.
Stern T, Hunt J, Norton HJ.
PURPOSE: Previously we described a computerized asthma decision support system and measured its accuracy in classifying asthma severity using pulmonologists as the gold standard. It is possible that the computerized decision support system may outperform pulmonologists in classifying asthma severity. The purpose of this study was to determine whether the computerized decision support system or pulmonologists have better accuracy with the 2007 edition of the Global Initiative for Asthma guidelines in classifying asthma severity. DESIGN. One hundred asthma case scenarios were developed by a medical resident and classified according to the 2007 Global Initiative for Asthma guidelines. These case scenarios were deemed the gold standard. These case scenarios were then entered into a computerized asthma decision support system and also presented to a group of 10 practicing pulmonologists. Sensitivity, specificity, and agreement were calculated for the computerized decision support system and the pulmonologists.
RESULTS: The sensitivity and specificity of the computerized decision support system was 100%. The sensitivity of the pulmonologist was 94.2% and the specificity was 70.0%. Agreement between the computerized decision support system and the gold standard was perfect with a Kappa = 1.00. The Kappa between the pulmonologists and the gold standard was equal to 0.672.
CONCLUSION: The computerized decision support system outperformed pulmonologists in the task of assigning asthma severity according to the 2007 Global Initiative for Asthma guidelines.
J Asthma. 2009 Nov;46(9):933-5.
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