Bayesian Diagnostic Probabilities without Assuming Independence of Symptoms

1991 ◽  
Vol 30 (01) ◽  
pp. 15-22 ◽  
Author(s):  
A. Gammerman ◽  
A. R. Thatcher
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Bayes Theorem ◽  
Bayes Method ◽  
Hospital Records ◽  
Computer Diagnosis ◽  
Bayes Model ◽  
Chi Squared ◽  
Past Data

The paper describes an application of Bayes’ Theorem to the problem of estimating from past data the probabilities that patients have certain diseases, given their symptoms. The data consist of hospital records of patients who suffered acute abdominal pain. For each patient the records showed a large number of symptoms and the final diagnosis, to one of nine diseases or diagnostic groups. Most current methods of computer diagnosis use the “Simple Bayes” model in which the symptoms are assumed to be independent, but the present paper does not make this assumption. Those symptoms (or lack of symptoms) which are most relevant to the diagnosis of each disease are identified by a sequence of chi-squared tests. The computer diagnoses obtained as a result of the implementation of this approach are compared with those given by the “Simple Bayes” method, by the method of classification trees (CART), and also with the preliminary and final diagnoses made by physicians.

scholarly journals Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

2018 ◽  
Vol 27 (2) ◽  
pp. 79-86
Author(s):  
Nalan Kozaci ◽  
Mustafa Avci ◽  
Gul Tulubas ◽  
Ertan Ararat ◽  
Omer Faruk Karakoyun ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Physician ◽  
Gold Standard ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Abdominal Ultrasonography

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

Can Surgical Registrars Accurately Identify the Urgent from the Non-Urgent Patient Presenting with Acute Abdominal Pain?

2019 ◽  
Vol 60 (1-2) ◽  
pp. 24-30 ◽  
Author(s):  
Kirsten J. de Burlet ◽  
Anna B.M. Lam ◽  
Simon J. Harper ◽  
Peter D. Larsen ◽  
Elizabeth R. Dennett
Keyword(s):  
Abdominal Pain ◽  
Patient Outcomes ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Initial Assessment ◽  
Wide Range ◽  
Urgent Patient ◽  
Hospital Resources ◽  
A Prospective Study ◽  
Diagnostic Skill

Background: Acute abdominal pain is a common surgical presentation with a wide range of causes. Differentiating urgent patients from non-urgent patients is important to optimise patient outcomes and the use of hospital resources. The aim of this study was to determine how accurately urgent and non-urgent patients presenting with abdominal pain can be identified. Methods: A prospective study of consecutive patients admitted with abdominal pain was undertaken. Urgent patients were classified as requiring treatment (theatre, intensive care unit, endoscopy, or radiologic drainage) within 24 h. Differentiation between urgent and non-urgent was made on the basis of the initial assessment prior to the use of advanced imaging. Outcomes were compared to a final classification based on final diagnosis as adjudicated by an expert panel. Results: Of the 301 patients included, 93 (30.9%) were deemed urgent based on initial assessment, compared to 83 (27.6%) on final diagnosis. Overall sensitivity for recognising urgent patients was 74.7% and specificity 89.9%, and overall accuracy was higher for senior registrars compared to junior registrars (p = 0.015). Urgent patients more often looked unwell or had peritonism on examination (39.8 vs. 17.4% and 56.6 vs. 14.7%, respectively, p < 0.001 for both). Conclusions: Registrars can accurately differentiate urgent from non-urgent patients with acute abdominal pain in the majority of cases. Accuracy was higher amongst senior registrars. The “end-of-the-bed-o-gram” and clinical examination are the most important features used for making this differentiation. This demonstrates that there is no substitute for exposure to acute presentations to improve a trainee’s diagnostic skill.

scholarly journals CT in the diagnosis of nontraumatic acute abdominal pain: clinical cases

2019 ◽  
pp. 82-89
Author(s):  
A. V. Arablinskii ◽  
Yu. A. Magdebura
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
Acute Abdominal Pain ◽  
Abdominal Cavity ◽  
Selection Criterion ◽  
Final Diagnosis ◽  
Diagnostic Process ◽  
Medical File ◽  
Moscow City ◽  
Ct Data

Acute abdominal pain (AAP) is a clinical symptom complex that develops with injuries and acute surgical diseases of the abdominal organs. This condition is one of the most frequent causes of admission of patients to the hospital through the ambulance. Patients with AAP consist of a large and heterogeneous group at the same time due to the etiology and many variations of the clinical picture of this condition. The article presents the results of CT scan of the abdominal cavity and small pelvis in 5 patients with AAP admitted to the S.P. Botkin Moscow City Clinical Hospital emergency department during 2017–2018, without indication of the possible traumatic nature of the pathology. All patients underwent a primary surgeon examination and first-line medical imaging methods such as plane radiography and ultrasound. The selection criterion for inclusion in the search was the need for CT due to the lack of data obtained for diagnosis. Subsequently, the findings of the CT scan were compared with the final diagnosis in the electronic medical file of the patient concerned, to assess the contribution of CT data to the diagnostic process. In a group of 5 patients included in the study, the results of CT were the decisive step in the diagnostic process in 100% of cases. Therefore, the study emphasizes the importance of using CT in patients with AAP. Using this method allows you to complete a diagnostic search as soon as possible from the time the patient enters the hospital, to begin timely treatment.

scholarly journals Impact of Clinical Experience and Diagnostic Performance in Patients with Acute Abdominal Pain

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Helena Laurell ◽  
Lars-Erik Hansson ◽  
Ulf Gunnarsson
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Performance ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Emergency Department Physician ◽  
Time Of Arrival ◽  
Base Line ◽  
Preliminary Diagnosis ◽  
One Year

Background.The aims were to evaluate the importance of the formal competence of the emergency department physician, the patient’s time of arrival at the emergency department, and the use of a structured schedule for investigation of patients with acute abdominal pain.Methods.Patients attending the Mora Hospital with acute abdominal pain from 1997 to 2000 were registered prospectively according to a structured schedule. Registration included history, symptoms, signs, preliminary diagnosis, surgery and final diagnosis after at least one year.  Results.3073 acute abdominal pain patients were included. The preliminary diagnosis, as compared with the final diagnosis, was correct in 54%(n=1659). Previously, during 1996, a base-line registration of 790 patients had a 58% correct diagnoses  (n=458). A majority of the patients (n=2699; 88%) were managed by nonspecialists. The proportion of correct diagnoses was 54%(n=759)for pre-registrar house officers and 55%(n=443)for senior house officers. Diagnostic performance at the emergency department was independent of patient’s time of arrival.Conclusions.A structured schedule for investigation did not improve the diagnostic precision at the emergency department in patients with acute abdominal pain. The diagnostic performance was independent of the formal competence of the physician and the patient's time of arrival.

Abdominal Pain

2014 ◽  
Vol 25 (3) ◽  
pp. 266-278 ◽  
Author(s):  
Helen F. Brown ◽  
Lynn Kelso
Keyword(s):  
Abdominal Pain ◽  
Patient Outcomes ◽  
Systematic Approach ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Multiple Organ ◽  
Appropriate Treatment ◽  
Organ Systems ◽  
Life Threatening ◽  
Cardinal Symptom

Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician’s goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation.

The Relative Accuracy of a Variety of Medical Diagnostic Programs

1994 ◽  
Vol 33 (04) ◽  
pp. 402-416 ◽  
Author(s):  
B. S. Todd ◽  
R. Stamper
Keyword(s):  
Abdominal Pain ◽  
Conditional Independence ◽  
Acute Abdominal Pain ◽  
Bayes Theorem ◽  
Clinical Use ◽  
Knowledge Based ◽  
Nearest Neighbours ◽  
Computer Aided ◽  
Medical Diagnostic ◽  
Aided Diagnosis

Abstract:Acute abdominal pain is one of the most widely studied applications of computer-aided diagnosis. The usual approach is to apply Bayes’ theorem with the assumption of conditional independence (“independence Bayes”). We compared various approaches to designing diagnostic programs for abdominal pain of suspected gynaecological origin. The methods range from statistical to knowledge-based. All programs were evaluated using a database of 1,270 cases collected retrospectively. Our results suggest that in this application no significant improvement in accuracy can be made by taking interactions into account, either by statistical or by knowledge-based means; independence Bayes is near-optimal. As far as accuracy is concerned, there appears to be little point in pursuing knowledge-based approaches. However, the “nearest neighbours” method using a new metric appears to be at least as accurate as independence Bayes. We argue that the nearest neighbours method is more suitable than independence Bayes for clinical use because of greater accountability.

scholarly journals Diagnostic Accuracy of Serum and Urine S100A8/A9 and Serum Amyloid A in Probable Acute Abdominal Pain at Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Arash Forouzan ◽  
Kambiz Masoumi ◽  
Fakher Rahim ◽  
Meisam Moezzi ◽  
Ali Khavanin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Accuracy ◽  
Serum Amyloid A ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Serum Amyloid ◽  
Amyloid A ◽  
Significant Difference ◽  
Serum And Urine

Study Design. This study was performed to investigate the diagnostic values of some inflammatory biomarkers in abdominal pain. Methods. Patients over 18 years of age with acute recent abdominal pain who presented to the Emergency Department were evaluated. Serum and urinary samples were taken and evaluated for serum and urine S100A8/A9 and serum amyloid A. All patients were referred to a surgeon and were followed up until the final diagnosis. In the end, the final diagnosis was compared with the levels of biomarkers. Results. Of a total of 181 patients, 71 underwent surgery and 110 patients did not need surgery after they were clinically diagnosed. Mean levels of serum and urine S100A8/A9 had a significant difference between two groups, but serum amyloid A did not show. The diagnostic accuracy of serum S100A8/A9, urine S100A8/A9, and serum amyloid A was 86%, 79%, and 50%, respectively, in anticipation of the need or no need for surgery in acute abdominal pain. Conclusions. Our study showed that in acute abdominal pain, serum and urine S100A8/A9 can be useful indicators of the need for surgery, but serum amyloid A had a low and nonsignificant diagnostic accuracy.

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

Sonographic evaluation of acute abdominal pain in children

Choonpa Igaku ◽  
2011 ◽  
Vol 38 (3) ◽  
pp. 243-254
Author(s):  
Atsushi YODEN ◽  
Tomoki AOMATSU
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Sonographic Evaluation
Sign in / Sign up

Export Citation Format

Share Document