Related Experiment Video
Updated: Jul 5, 2026
Advancing Dyslexia Assessment in Children Through Computerized Testing
Published on: August 16, 2024
An international assessment of a web-based diagnostic tool in critically ill children
Neal J Thomas1, Padmanabhan Ramnarayan, Michael J Bell
1Penn State Children's Hospital and The Pennsylvania State University College of Medicine, Hershey, PA, USA. nthomas@psu.edu
Insights
Diagnostic uncertainty affects 22.2% of pediatric intensive care unit admissions. A computerized diagnostic tool and attending physician input improved diagnostic accuracy in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Informatics
- Diagnostic Accuracy
Background:
- Diagnostic uncertainty is common in critically ill children.
- The impact of diagnostic tools on trainee performance needs further investigation.
Purpose of the Study:
- To assess the extent of diagnostic uncertainty in pediatric intensive care unit (PICU) admissions.
- To evaluate the improvement in pediatric trainee diagnostic accuracy using a computerized diagnostic tool and attending physician input.
Main Methods:
- Collected patient data from five PICUs, including clinical details, diagnostic workup, and discharge diagnoses.
- Trainee diagnostic accuracy was compared to discharge diagnoses (gold standard).
- Assessed accuracy with the diagnostic tool alone and with added attending physician suggestions.
Main Results:
- 22.2% of admissions lacked an established diagnosis upon arrival.
- Trainee diagnostic accuracy was 89.4%, improving to 92.5% with the tool and 95% with attending physician input.
- The diagnostic tool and physician input significantly enhanced diagnostic performance.
Conclusions:
- Diagnostic uncertainty is present in a notable proportion of PICU admissions.
- Computerized diagnostic aids and expert consultation can improve diagnostic accuracy in critically ill children.
- These tools may be particularly beneficial in settings with less specialized expertise.
Abstract:
Improving diagnostic accuracy is essential. The extent of diagnostic uncertainty at patient admission is not well described in critically ill children. Therefore, we studied the extent that pediatric trainee diagnostic performance could be improved with the aid of a computerized diagnostic tool. Data regarding patient admissions to five Pediatric Intensive Care Units were collected. Information included patients' clinical details, admitting team's diagnostic workup and discharge diagnosis. An attending physician assessed each case independently and suggested additional diagnostic possibilities. Diagnostic accuracy was calculated using the discharge diagnosis as the gold standard. 206 out of 927 patients (22.2%) admitted to the PICUs did not have an established diagnosis at admission. The trainee teams considered a median of three diagnoses in their workup (IQR 3-5) and made an accurate diagnosis in 89.4% cases (95% CI 84.6%-94.2%). Diagnostic accuracy improved to 92.5% with use of the diagnostic tool alone, and to 95% with the addition of attending physicians' diagnostic suggestions. We conclude that a modest proportion of admissions to these PICUs were characterized by diagnostic uncertainty during initial assessment. Although there was a relatively high accuracy rate of initial assessment in our clinical setting, it was further improved by both the diagnostic tool and the physicians' diagnostic suggestions. It is plausible that the tool's utility would be even greater in clinical settings with less expertise in critical illness assessment, such as community hospitals, or emergency departments of non-training institutions. The role of diagnostic aids in the care of critically ill children merits further study.further study.