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. 2011 Oct;61(591):e674-9.
doi: 10.3399/bjgp11X601398.

Does a decision aid help physicians to detect chronic obstructive pulmonary disease?

Berna D L Broekhuizen  1 , Alfred Sachs, Kristel Janssen, Geert-Jan Geersing, Karel Moons, Arno Hoes, Theo Verheij
Affiliations

Does a decision aid help physicians to detect chronic obstructive pulmonary disease?

Berna D L Broekhuizen et al. Br J Gen Pract. 2011 Oct.

Abstract

Background: Numerous decision aids have been developed recently, but the value they add above that of the initial clinical assessment is not well known.

Aim: To quantify whether a formal decision aid for chronic obstructive pulmonary disease (COPD) adds diagnostic information, above the physician's clinical assessment.

Design and setting: Subanalysis of a diagnostic study in Dutch primary care.

Method: Sixty-five primary care physicians included 357 patients who attended for persistent cough and were not known to have COPD. The physicians estimated the probability of COPD after short history taking and physical examination. After this, the presence or absence of COPD was determined using results of extensive diagnostic work-up. The extent to which an 8-item decision aid for COPD, which included only symptoms and signs, added diagnostic value above the physician's estimation was quantified by the increase of the area under the receiver operating characteristic curve (ROC area), and the improvement in diagnostic risk classification across two classes: 'low probability of COPD' (<20%) and 'possible COPD' (≥20%).

Results: One hundred and four patients (29%) had COPD. Adding the decision aid to the clinical assessment increased the ROC area from 0.75 (95% confidence interval [CI] = 0.70 to 0.81) to 0.84 (95% CI = 0.80 to 0.89) (P<0.005), and improved the diagnostic risk classification of the patients, such that 35 fewer patients needed spirometry testing and eight fewer COPD cases were missed.

Conclusion: A short decision aid for COPD added diagnostic value to the physician's clinical assessment.

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Figures

Figure 1
Figure 1
Flow chart of the study and participants.
Figure 2
Figure 2
Receiver operating characteristic curves of the physician's assessment and the physician's assessment plus the decision aid's estimate combined.
Figure 3
Figure 3
Diagnostic risk stratification by physicians compared to physician's estimation and decision aid combined.
See this image and copyright information in PMC

References

    1. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–555. - PubMed
    1. Levy ML, Quanjer PH, Booker R, et al. Diagnostic spirometry in primary care: Proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations. Prim Care Respir J. 2009;18(3):130–147. - PMC - PubMed
    1. Bednarek M, Maciejewski J, Wozniak M, et al. Prevalence, severity and underdiagnosis of COPD in the primary care setting. Thorax. 2008;63(5):402–407. - PubMed
    1. Broekhuizen BD, Sachs AP, Hoes AW, et al. Undetected chronic obstructive pulmonary disease and asthma in people over 50 years with persistent cough. Br J Gen Pract. 2010;60(576):489–494. - PMC - PubMed
    1. Royston P, Moons KG, Altman DG, Vergouwe Y. Prognosis and prognostic research: Developing a prognostic model. BMJ. 2009;338:b604. - PubMed

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