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[The use of computer-assisted clinical consultation with expert systems in early pregnancy]
1II Katedry i Kliniki Ginekologii Akademii Medycznej we Wrocławiu.
Objectives:
The early pregnancy disorders are most frequent diagnostic problem in a GP-practice. This observation and commonness of the problem inclined the authors to assume eutopic physiological pregnancy, eutopic complicated pregnancy, ectopic pregnancy and trophoblastic diseases as important diagnostic hypotheses for our knowledge based consultation system, intended as decision support tool for first contact physician (GP) when diagnosing early pregnancy disorders.
Design:
Defining 81 diagnostic tests to be included in the knowledge acquisition process, interviewing clinical experts and developing knowledge base (set of clinical diagnostic rules), implementing the knowledge base for early pregnancy disorders--related amenorrhea patients, in particular: determining clinical importance of symptoms and lab/diagnostic tests.
Materials And Methods:
The clinical knowledge acquisition process has been performed taking into account 81 diagnostic features. Moreover clinical data on 220 cases, including 96 early pregnancy disorders cases, have been collected to enable validation of the knowledge base. ELSA approach to creating environment-self-adjustable medical knowledge bases, developed by Ruszkowski has been applied and the eleven main diagnostic hypotheses have been defined. We believe that the proposed knowledge base and PC-based consultation system offers such an approach for improving GP diagnostic effectiveness.
Results And Conclusions:
1. The knowledge base and the consultation system could contribute to improving diagnostic effectiveness, when used by a GP for diagnosing early pregnancy disorders such an approach could also be used to determine relative diagnostic power of specific tests or symptoms, 2. The laboratory and diagnostic test confirmed high diagnostic accuracy in early pregnancy disorders. The anamnesis has a low diagnostic effectiveness for particular diagnostic features in ectopic pregnancy patients and physical examination confirmed low diagnostic accuracy in eutopic physiological pregnancy and eutopic complicated pregnancy.