Diagnosis of complex acid-base disorders: physician performance versus the microcomputer

Area of Science:

• Medical Informatics
• Clinical Chemistry
• Emergency Medicine

Background:

• Emergency departments (EDs) frequently encounter patients with complex acid-base disturbances.
• The fast-paced ED environment can hinder accurate quantitative analysis of these disorders, particularly mixed acid-base disturbances.

Purpose of the Study:

• To develop and evaluate a microcomputer program for the rapid quantitative analysis of acid-base disturbances.
• To compare the diagnostic accuracy and speed of the computer program with physician performance in identifying single, double, and triple acid-base disorders.

Main Methods:

• A computer program was developed using standard acid-base and electrolyte formulas for Apple II+ or IBM-PC microcomputers.
• The program analyzed 35 distinct acid-base disturbances (single, double, and triple disorders).
• Physicians (n=21) from various specialties were given the same problem sets and asked to diagnose disorders as they would in an ED setting.

Main Results:

• The computer program correctly identified all 35 acid-base disturbances in under 45 seconds.
• Physician correct response rates were 86% for single, 49% for double, and 17% for triple disorders.
• Physicians achieved higher correct response rates for identifying the primary disorder (89% for double, 94% for triple), but lower rates for identifying primary and secondary disorders (58% for triple).

Conclusions:

• Microcomputer-based analysis offers a potentially beneficial tool for the rapid and accurate assessment of complex acid-base disturbances in the ED.
• Physician diagnostic accuracy decreases significantly with the complexity of acid-base disorders.
• Computer assistance may improve diagnostic efficiency and accuracy in time-sensitive emergency settings.