Clinical decision support systems (CDSS) in assistance to COVID-19 diagnosis: A scoping review on types and evaluation methods

Abstract

Background and aims: Due to the COVID-19 pandemic, a precise and reliable diagnosis of this disease is critical. The use of clinical decision support systems (CDSS) can help facilitate the diagnosis of COVID-19. This scoping review aimed to investigate the role of CDSS in diagnosing COVID-19.

Methods: We searched four databases (Web of Science, PubMed, Scopus, and Embase) using three groups of keywords related to CDSS, COVID-19, and diagnosis. To collect data from studies, we utilized a data extraction form that consisted of eight fields. Three researchers selected relevant articles and extracted data using a data collection form. To resolve any disagreements, we consulted with a fourth researcher.

Results: A search of the databases retrieved 2199 articles, of which 68 were included in this review after removing duplicates and irrelevant articles. The studies used nonknowledge-based CDSS (n = 52) and knowledge-based CDSS (n = 16). Convolutional Neural Networks (CNN) (n = 33) and Support Vector Machine (SVM) (n = 8) were employed to design the CDSS in most of the studies. Accuracy (n = 43) and sensitivity (n = 35) were the most common metrics for evaluating CDSS.

Conclusion: CDSS for COVID-19 diagnosis have been developed mainly through machine learning (ML) methods. The greater use of these techniques can be due to their availability of public data sets about chest imaging. Although these studies indicate high accuracy for CDSS based on ML, their novelty and data set biases raise questions about replacing these systems as clinician assistants in decision-making. Further studies are needed to improve and compare the robustness and reliability of nonknowledge-based and knowledge-based CDSS in COVID-19 diagnosis.

Keywords: COVID‐19; clinical; computer‐assisted decision‐making; decision support systems; intelligent clinical decision support system (ICDSS); medical diagnosis.

Figure 1

PRISMA‐ScR flowchart showing the search process. CDSS, clinical decision support systems; PRISMA‐ScR, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline extension for scoping reviews; WOS, Web of Sciences.

Figure 2

Distribution of the studies in terms of publication year.

Figure 3

Number of publications by country based on authors' countries.

Figure 4

Types of CDSS in the selected studies. CDSS, clinical decision support systems; ES, expert systems; ICDSS, intelligent clinical decision support systems; ML, machine learning.