iPhoneのApple app storeや AndroidなどのGoogle Playで｢Symptom checker"や"medical diagnosis"と検索されたアプリの検証
Evaluation of symptom checkers for self diagnosis and triage: audit study
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3480 (Published 08 July 2015)
４５の標準化された患者ビグネットをコンパイルし、緊急性トリアージのカテゴリー３区分としたもので、例えば肺塞栓のような緊急ケア必要なもの、中耳炎のような非緊急性なもの、ウィルス性上気道感染のような自己管理可能なものに分ける。
診断を提供する徴候チェッカーによる主要アウトカムが初期２０の候補診断を正確に当てられるか？本来の意味から言えば正確に緊急状態を篩い分けられるか？
Evaluation of symptom checkers for self diagnosis and triage: audit study
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3480 (Published 08 July 2015)
２３の徴候チェッカーは、標準化患者評価の正診率 34％（95％信頼区間 31％〜37％）、トップ20に限れば58％（55％〜62％）、適正なトリアージ助言比率としては57％ （52％〜61％）
状況によりトリアージパフォーマンスばらつき
緊急事態では、助言適正比率 80％（95％信頼区間、 75％〜86％）
非緊急性では、55％ （47％〜63％）
自己管理疾患では、 33％ （28％〜40％）
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23の個別徴候チェッカー横断的には、適切なトリアージ助言パフォーマンスは 33％ (95% 信頼区間19% to 48%) 〜78％(64% to 91%)の範囲
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Symptom checker
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Description
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Maximum No of diagnoses*
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Triage options provided
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AskMD (USA)
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Online health and wellness platform from Sharecare (www.sharecare.com/askmd/get-started)
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15
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Not available
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BetterMedicine (USA)
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Health resource from HealthGrades; symptom checker provides possible diagnoses and information about these conditions (www.bettermedicine.com/symptom-checker/)
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46
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Not available
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DocResponse (USA)
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Symptom checker started by a group of certified physicians; user can choose from internal medicine, dermatology, and orthopedic views (www.docresponse.com/)
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5
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Not available
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Doctor Diagnose (USA)
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App offered on Google Play; provides potential diagnoses and triage advice in some cases
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3
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Seek immediate care; call your doctor now; speak with your doctor; home care
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Drugs.com (USA)
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Online resource for drug and related health information; uses content from Harvard Health Publications (www.drugs.com/symptom-checker/)
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10
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Emergency department; primary care doctor; home care
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EarlyDoc (Netherlands)
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For triage criteria, uses Dutch College of General Practitioners (NHG) TriageWijzer and the Australian Triage Scale (used in Australia and New Zealand to assess urgency) (www.earlydoc.com/en/)
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3
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Don’t wait, and call a doctor now; call a doctor preferably today; see your doctor preferably on a weekday; your complaints don’t seem urgent
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Esagil (USA)
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Provides list of likely diagnoses (based on number of entered symptoms that are congruent with diagnosis); user can also enter blood and urine lab results along with symptoms (http://esagil.org/)
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65
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Not available
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Family Doctor (USA)
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Displays flow chart to track symptoms to diagnosis and triage option; created by American Academy of Physicians (http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom.html)
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7
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Emergency room; see your doctor; home care
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FreeMD (USA)
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Takes user through a series of questions in a “check-up” to finish with “what might be wrong with you” and “where to go for care”; owned by DSHI Systems, which provides triage decision support solutions from emergency medicine physicians to the US government (Department of Veteran Affairs) and private sector companies; program called TriageXpert (www.freemd.com/)
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3
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Emergency department; urgent care; doctor’s office; doctor e-visit; retail clinic; dentist; home care
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Harvard Medical School Family Health Guide (USA)
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From Harvard Health Publications; available both online and in print.† (www.health.harvard.edu/fhg/symptoms/symptoms.shtml)
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4
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Emergency department; general practice; home care
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Healthline (USA)
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Health and wellness website that licenses content to employers, health providers, and health plans (www.healthline.com/symptom-checker)
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76
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Not available
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Healthwise (USA)
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Non-profit provider for health content and patient education; symptom checker licensed to other organizations; we accessed using Province of Alberta’s website (https://myhealth.alberta.ca/health/pages/symptom-checker.aspx)
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Not available
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Call 911 now; seek care now; seek care today; try home care
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Healthy Children (USA)
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From American Academy of Pediatrics; use’s Barton D Schmitt’s “Pediatric HouseCalls Symptom Checker” triage protocol (www.healthychildren.org/English/tips-tools/symptom-checker)
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Not available
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Call 911 now; call your doctor now (night or day); call your doctor within 24 hours; call your doctor during weekday office hours; parent care at home
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Isabel (UK)
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Created by Isabel Medical Charity (http://symptomchecker.isabelhealthcare.com/suggest_diagnoses_advanced/landing_page)
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10
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Walk-in care; family doctor; emergency services
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iTriage (USA)
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Owned by Aetna; provides clinical sites in user’s region with addresses and phone numbers (www.itriagehealth.com/avatar)
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5
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Emergency department, urgent care, retail clinic, family practice, internal medicine, specialties, prescription medication, over the counter medication
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Mayo Clinic (USA)
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Health resource website (www.mayoclinic.org/symptom-checker/select-symptom/itt-20009075)
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20
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Not available
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MEDoctor (USA)
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Free differential diagnosis system (www.medoctor.com/)
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3
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Not available
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NHS Symptom Checkers (UK)
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Available through England’s National Health Services (NHS) Choices website (www.nhs.uk/symptomcheckers/pages/symptoms.aspx)
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Not available
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Emergency department; general practitioner; home care
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Steps2Care (USA)
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iPhone and Android app; provides symptom care guides from Barton D Schmitt’s pediatric telephone triage guidelines and David A Thompson’s adult telephone triage guidelines
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Not available
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Call 911 now; go to emergency room now; call doctor now or go to emergency room; call doctor within 24 hours; call doctor during office hours; self care at home
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Symcat (USA)
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Triage tool uses data linking specific patient symptoms and physician diagnoses across visits seen in the National Ambulatory Medical Care Survey (NAMCS) (www.symcat.com/)
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6
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Primary care; retail clinic; emergency room; urgent care
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Symptify (USA)
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Online self assessment tool and other health services, including, for example, emergency contact list, consultation list (https://symptify.com/)
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9
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Emergency room; urgent care; home care; inconclusive
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Symptomate (Poland)
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Uses bayesian network methodology and medical database for diagnoses (https://symptomate.com/)
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5
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Emergency room; specialist; general practitioner
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WebMD (USA)
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Medical reference and healthcare resource website (http://symptoms.webmd.com)
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99
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Not available
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