Quantifying Clinicians' Diagnostic Uncertainty When Making Initial Treatment Decisions for Microbial Keratitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Medical Decision Making

Background:

• Microbial keratitis (MK) is a serious eye infection requiring prompt diagnosis and management.
• Physician diagnostic uncertainty can impact initial treatment decisions for MK.
• Establishing risk thresholds is crucial for developing predictive models and decision support tools.

Purpose of the Study:

• To determine the diagnostic uncertainty among corneal specialists regarding the initial management of microbial keratitis (MK).
• To establish risk thresholds for treating different types of MK based on ulcer characteristics.
• To inform the development of prediction models and decision support tools for MK treatment.

Main Methods:

• A cross-sectional survey was administered to corneal specialists with at least two years of clinical experience.
• Clinicians reported the percentage risk at which they would initiate or withhold treatment for various MK types (bacterial, fungal, herpetic, amoebic).
• Treatment thresholds were assessed based on initial ulcer size (<2 mm² central, <2 mm² peripheral, >8 mm² central).

Main Results:

• Seventy-two ophthalmologists participated, with diverse experience and practice settings.
• Treatment thresholds varied significantly by MK type, ulcer size, and central location.
• Thresholds to initiate treatment were lower for larger and central infections (P < 0.001).
• Treatment thresholds differed between US and international clinicians for specific MK types (P < 0.001).

Conclusions:

• Risk thresholds for treating microbial keratitis are influenced by practice location, MK type, ulcer size, and location.
• These established thresholds can quantify clinical uncertainty in MK management.
• The findings support the development of decision support tools to aid clinicians in MK treatment decisions.