Three quantitative approaches to the diagnosis of abdominal pain in children: Practical applications of decision theory
Background/Purpose: The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined...
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Published in | Journal of pediatric surgery Vol. 36; no. 9; pp. 1375 - 1380 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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Philadelphia, PA
Elsevier Inc
01.09.2001
Elsevier |
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Abstract | Background/Purpose: The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints. Methods: The records of all children (1,208) seen at a large urban emergency department (ED) with a chief complaint of abdominal pain were immediately reviewed retrospectively (24 to 72 hours after the encounter). Attempts were made to contact all the patients' families to determine an accurate final diagnosis. A total of 1,008 (83%) families were contacted. Data were analyzed by calculation of the posttest probability, recursive partitioning, and binary logistic regression. Results: In all groups the most common diagnosis was abdominal pain (ICD-9 Code 789). After this, however, the order of the most common final diagnoses for abdominal pain varied significantly. The entire group had a pretest probability of appendicitis of 0.06. This varied with age and sex from 0.02 in boys 2 to 5 years old to 0.16 in boys older than 12 years. In boys age 5 to 12, recursive partitioning and binary logistic regression agreed on guarding and anorexia as important variables. Guarding and tenderness were important in girls age 5 to 12. In boys age greater than 12, both agreed on guarding and anorexia. Using sensitivities and specificities from the literature, computed tomography improved the posttest probability for the group from.06 to.33; ultrasound improved it from.06 to.48; and barium enema improved it from.06 to.58. Conclusions: Knowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer. J Pediatr Surg 36:1375-1380. Copyright © 2001 by W.B. Saunders Company. |
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AbstractList | BACKGROUND/PURPOSEThe authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints.METHODSThe records of all children (1,208) seen at a large urban emergency department (ED) with a chief complaint of abdominal pain were immediately reviewed retrospectively (24 to 72 hours after the encounter). Attempts were made to contact all the patients' families to determine an accurate final diagnosis. A total of 1,008 (83%) families were contacted. Data were analyzed by calculation of the posttest probability, recursive partitioning, and binary logistic regression.RESULTSIn all groups the most common diagnosis was abdominal pain (ICD-9 Code 789). After this, however, the order of the most common final diagnoses for abdominal pain varied significantly. The entire group had a pretest probability of appendicitis of 0.06. This varied with age and sex from 0.02 in boys 2 to 5 years old to 0.16 in boys older than 12 years. In boys age 5 to 12, recursive partitioning and binary logistic regression agreed on guarding and anorexia as important variables. Guarding and tenderness were important in girls age 5 to 12. In boys age greater than 12, both agreed on guarding and anorexia. Using sensitivities and specificities from the literature, computed tomography improved the posttest probability for the group from.06 to.33; ultrasound improved it from.06 to.48; and barium enema improved it from.06 to.58.CONCLUSIONSKnowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer. Background/Purpose: The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints. Methods: The records of all children (1,208) seen at a large urban emergency department (ED) with a chief complaint of abdominal pain were immediately reviewed retrospectively (24 to 72 hours after the encounter). Attempts were made to contact all the patients' families to determine an accurate final diagnosis. A total of 1,008 (83%) families were contacted. Data were analyzed by calculation of the posttest probability, recursive partitioning, and binary logistic regression. Results: In all groups the most common diagnosis was abdominal pain (ICD-9 Code 789). After this, however, the order of the most common final diagnoses for abdominal pain varied significantly. The entire group had a pretest probability of appendicitis of 0.06. This varied with age and sex from 0.02 in boys 2 to 5 years old to 0.16 in boys older than 12 years. In boys age 5 to 12, recursive partitioning and binary logistic regression agreed on guarding and anorexia as important variables. Guarding and tenderness were important in girls age 5 to 12. In boys age greater than 12, both agreed on guarding and anorexia. Using sensitivities and specificities from the literature, computed tomography improved the posttest probability for the group from.06 to.33; ultrasound improved it from.06 to.48; and barium enema improved it from.06 to.58. Conclusions: Knowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer. J Pediatr Surg 36:1375-1380. Copyright © 2001 by W.B. Saunders Company. The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints. The records of all children (1,208) seen at a large urban emergency department (ED) with a chief complaint of abdominal pain were immediately reviewed retrospectively (24 to 72 hours after the encounter). Attempts were made to contact all the patients' families to determine an accurate final diagnosis. A total of 1,008 (83%) families were contacted. Data were analyzed by calculation of the posttest probability, recursive partitioning, and binary logistic regression. In all groups the most common diagnosis was abdominal pain (ICD-9 Code 789). After this, however, the order of the most common final diagnoses for abdominal pain varied significantly. The entire group had a pretest probability of appendicitis of 0.06. This varied with age and sex from 0.02 in boys 2 to 5 years old to 0.16 in boys older than 12 years. In boys age 5 to 12, recursive partitioning and binary logistic regression agreed on guarding and anorexia as important variables. Guarding and tenderness were important in girls age 5 to 12. In boys age greater than 12, both agreed on guarding and anorexia. Using sensitivities and specificities from the literature, computed tomography improved the posttest probability for the group from.06 to.33; ultrasound improved it from.06 to.48; and barium enema improved it from.06 to.58. Knowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer. |
Author | Rosenberg, Norman M. Durham, Todd Thomas, Ronald L. Rood, Kim D. Langenburg, Scott E. Kuhns, Larry R. Bahr, M.James Klein, Michael D. Rabbani, Amir B. |
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Cites_doi | 10.1056/NEJM199406233302506 10.1001/archsurg.1990.01410140139024 10.1177/000313489906501013 10.1016/S0196-0644(05)80976-X 10.1136/bmj.293.6550.800 10.1056/NEJM198209023071004 |
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Keywords | decision-support appendicitis abdominal pain medical informatics Quantitative decision making Human Pain Decision theory Abdominal disease Digestive diseases Biomathematics Diagnosis Child Statistical study Abdomen Quantitative analysis |
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References | Oliak, Sinow, French (bib3) 1999; 65 Van Way, Murphy, Dunn (bib12) 1982; 155 Sox, Blatt, Higgins (bib2) 1988 Crady, Jones, Wyn (bib4) 1993; 22 Shortliffe, Perreault (bib7) 1990 Adams, Chan, Clifford (bib10) 1986; 293 el Ferzli, Ozuner, Davidson (bib5) 1990; 171 Goldman (bib8) 1998 Thompson, Bennion, Doty (bib11) 1990; 124 Breiman, Jerome, Olshen (bib6) 1984 Edwards, Davies (bib13) 1984; 158 Goldman, Weinberg, Weisberg (bib9) 1982; 307 Berner, Webster, Shugerman (bib1) 1994; 330 Thompson (10.1053/jpsu.2001.26374_bib11) 1990; 124 Berner (10.1053/jpsu.2001.26374_bib1) 1994; 330 Adams (10.1053/jpsu.2001.26374_bib10) 1986; 293 Breiman (10.1053/jpsu.2001.26374_bib6) 1984 Shortliffe (10.1053/jpsu.2001.26374_bib7) 1990 Sox (10.1053/jpsu.2001.26374_bib2) 1988 Crady (10.1053/jpsu.2001.26374_bib4) 1993; 22 Goldman (10.1053/jpsu.2001.26374_bib8) 1998 Oliak (10.1053/jpsu.2001.26374_bib3) 1999; 65 Edwards (10.1053/jpsu.2001.26374_bib13) 1984; 158 el Ferzli (10.1053/jpsu.2001.26374_bib5) 1990; 171 Goldman (10.1053/jpsu.2001.26374_bib9) 1982; 307 Van Way (10.1053/jpsu.2001.26374_bib12) 1982; 155 |
References_xml | – volume: 330 start-page: 1792 year: 1994 end-page: 1794 ident: bib1 article-title: Performance of four computer-based diagnostic systems publication-title: N Engl J Med contributor: fullname: Shugerman – volume: 307 start-page: 588 year: 1982 end-page: 596 ident: bib9 article-title: A computer-derived protocol to aid In the diagnosis of emergency room patients with acute chest pain publication-title: N Engl J Med contributor: fullname: Weisberg – year: 1998 ident: bib8 article-title: Quantitative Aspects of Clinical Reasoning publication-title: Harrison's Principles of Internal Medicine contributor: fullname: Goldman – year: 1988 ident: bib2 article-title: Medical Decision Making contributor: fullname: Higgins – volume: 65 start-page: 959 year: 1999 end-page: 964 ident: bib3 article-title: Computed tomography scanning for the diagnosis of perforated appendicitis publication-title: Am Surg contributor: fullname: French – volume: 171 start-page: 40 year: 1990 end-page: 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ident: bib10 article-title: Computer aided diagnosis of acute abdominal pain: A multicentre study publication-title: Br Med J contributor: fullname: Clifford – year: 1984 ident: bib6 article-title: Classification and Regression Trees contributor: fullname: Olshen – volume: 124 start-page: 261 year: 1990 end-page: 264 ident: bib11 article-title: Predictive factors for bactibilia in acute cholecystitis publication-title: Arch Surg contributor: fullname: Doty – volume: 155 start-page: 685 year: 1982 ident: 10.1053/jpsu.2001.26374_bib12 article-title: A feasibility study of computer aided diagnosis in appendicitis publication-title: Surg Gynecol Obstet contributor: fullname: Van Way – volume: 330 start-page: 1792 year: 1994 ident: 10.1053/jpsu.2001.26374_bib1 article-title: Performance of four computer-based diagnostic systems publication-title: N Engl J Med doi: 10.1056/NEJM199406233302506 contributor: fullname: Berner – volume: 124 start-page: 261 year: 1990 ident: 10.1053/jpsu.2001.26374_bib11 article-title: Predictive factors for bactibilia in acute cholecystitis publication-title: Arch Surg doi: 10.1001/archsurg.1990.01410140139024 contributor: fullname: Thompson – volume: 171 start-page: 40 year: 1990 ident: 10.1053/jpsu.2001.26374_bib5 article-title: Barium enema in the diagnosis of acute appendicitis publication-title: Surg Gynecol Obstet contributor: fullname: el Ferzli – volume: 65 start-page: 959 year: 1999 ident: 10.1053/jpsu.2001.26374_bib3 article-title: Computed tomography scanning for the diagnosis of perforated appendicitis publication-title: Am Surg doi: 10.1177/000313489906501013 contributor: fullname: Oliak – volume: 22 start-page: 1125 year: 1993 ident: 10.1053/jpsu.2001.26374_bib4 article-title: Clinical validity of ultrasound in children with suspected appendicitis publication-title: Ann Emerg Med doi: 10.1016/S0196-0644(05)80976-X contributor: fullname: Crady – year: 1988 ident: 10.1053/jpsu.2001.26374_bib2 contributor: fullname: Sox – volume: 293 start-page: 800 year: 1986 ident: 10.1053/jpsu.2001.26374_bib10 article-title: Computer aided diagnosis of acute abdominal pain: A multicentre study publication-title: Br Med J doi: 10.1136/bmj.293.6550.800 contributor: fullname: Adams – volume: 158 start-page: 219 year: 1984 ident: 10.1053/jpsu.2001.26374_bib13 article-title: Use of a bayesian algorithm in the computer-assisted diagnosis of appendicitis publication-title: Surg Gynecol Obstet contributor: fullname: Edwards – volume: 307 start-page: 588 year: 1982 ident: 10.1053/jpsu.2001.26374_bib9 article-title: A computer-derived protocol to aid In the diagnosis of emergency room patients with acute chest pain publication-title: N Engl J Med doi: 10.1056/NEJM198209023071004 contributor: fullname: Goldman – year: 1998 ident: 10.1053/jpsu.2001.26374_bib8 article-title: Quantitative Aspects of Clinical Reasoning contributor: fullname: Goldman – year: 1990 ident: 10.1053/jpsu.2001.26374_bib7 contributor: fullname: Shortliffe – year: 1984 ident: 10.1053/jpsu.2001.26374_bib6 contributor: fullname: Breiman |
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Snippet | Background/Purpose: The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the... The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common... BACKGROUND/PURPOSEThe authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the... |
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SubjectTerms | Abdomen abdominal pain Abdominal Pain - diagnosis Abdominal Pain - epidemiology Age Distribution appendicitis Appendicitis - diagnosis Appendicitis - epidemiology Biological and medical sciences Child Child, Preschool Decision Support Techniques decision-support Diagnosis, Differential Female Gastroenterology. Liver. Pancreas. Abdomen Humans Incidence Logistic Models Male medical informatics Medical sciences Other diseases. Semiology Predictive Value of Tests Probability Quantitative decision making Retrospective Studies Risk Factors Sensitivity and Specificity Severity of Illness Index Sex Distribution |
Title | Three quantitative approaches to the diagnosis of abdominal pain in children: Practical applications of decision theory |
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