PHYSICIANS WORKING DIAGNOSIS COMPARED TO THE EURICTERUS REAL-LIFE DATA DIAGNOSTIC-TOOL TRIAL(C) IN 3 JAUNDICE DATABASES - EURICTERUS DUTCH,INDEPENDENT PROSPECTIVE AND INDEPENDENT RETROSPECTIVE

Background/Aims: In the European Union Euricterus Project on (sub)Icte rus proforma, the history and physical examination items were to be us ed for the physician's working diagnosis (PWD) and ,among others, for the development of the real life data electronic diagnostic tool, Tria l(C). Trial(C) delivers diagnosis probabilities based on Bayes' Theore m (B), completed by Trial Algorithm (TA). We wanted to compare the dia gnostic accuracies (PWD and Trial(C) probabilities as a percentage of the final diagnosis (FD) in a patient population) in 3 Dutch databases . Methodology: The inclusion criteria for both Euricterus and Trial(C) were age greater than or equal to 16 and bilirubin greater than or eq ual to 20 mmol/l. Euricterus data gathering took place at the bedside on a proforma with (among other questions) 79 questions on, history an d physical examination as well as the diagnosis levels for the PWD (1 alternative possible) and FD (17 disease categories, dc). Trial(C) was developed on the data of 7,104 Euricterus patients and its data-entry Demo(C) has the same questions. It calculates the probability of each diagnosis of the 17 dc as a percentage, as each significant finding i s encountered (BO, Bayesian Overall). It can simultaneously calculate the resemblance of the patient's signs and symptoms to each disease co ncomitantly (BV, Bayesian Vertical), and to any subset of a disease. A ny probability is further tested for compatibility using TA, a subset of BV, delivering TA-PWD, TA-BO and TA-BV. The Trial(C) test patients came from 3 databases: a Euricterus Dutch Patients Random Sample EDRS (n=184, internal database) and 2 independent databases. prospective P (n=80) and retrospective R (n=152), totalling 416 patients. Results: T he accuracies of PWD and Trial(C) showed no differences between the da tabases, and the results are therefore pooled (n=416). With testing on the highest probability found, the PWD accuracy was 78%, TA-PWD 81%, TA-BO 74% and TA-BV 72%. The true FD's were mentioned (at any probabil ity) in the PWD in 86%, TA-PWD in 92%, TA-BO in 94% and TA-BV in 91% o f the patients. Testing only patients whose FD was ''certain'' or whos e data were without omissions did not improve accuracy. Testing on pro bability >95% improved BO and BV accuracy, but not TA-BO or TA-BV. Con clusions: The Physician's Working Diagnosis accuracy was approximately 80% and did not greatly improve after TA. The Trial(C) TA-BO and TA-B V accuracies were only slightly less than, the PWD. For well-trained p hysicians, Trial(C) strengthens the physician's judgment, and for thos e less trained (or those to be trained), it delivers a (sub)icterus di agnostic disease probability at nearly consultant level.