Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 7, 2024
Date Accepted: May 29, 2024
Date Submitted to PubMed: May 29, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Safety of self-triage by patients using a symptom-checker: a prospective surveillance study
ABSTRACT
Background:
Symptom-checker self-triage apps assist patients to determine the urgency of medical care. To be safe and effective, these tools must be validated, particularly to avoid potential hazardous undertriage.
Objective:
To investigate the safety of patient’s self-triage using a symptom-checker.
Methods:
A single centre, prospective clinical trial comparing the individual outcomes of patients’ self-triage with the assessment of the clinical urgency made by three successive interdisciplinary panels of physicians. Data collected between 25 November 2019 and 1 May 2020. Panel assessments and data analysis completed on 29 August 2022. Setting: Walk-in-Clinic and Interdisciplinary Emergency Department (WIC/ED) of the cantonal hospital of Baden, Switzerland. Partcipants: All patients ≥ 18 years attending the WIC/ED between 8:00 a.m. and 5:00 p.m. Exclusion criteria included ESI 1 and presence of symptoms not encompassed by the symptom-checker. 22 676 (12 655 ER, 10 021 WIC) used the facility during the enrollment period. 7550 patients attended WIC/ED within the recruitment window. 2550 gave informed consent, 7 patients withdrew. Intervention: Participants assessed their symptoms using SMASSPathfinder, a web-based symptom-checker based on a computerized transparent neural network. Main Outcome and Measure: The assessment by the panels encompassed the appropriate time-to-treat and the adequate point-of-care. If a case was adjudicated as undertriaged by the first two panels, the third panel assessed the patient’s risk to health or life, making a decision on whether a potentially hazardous undertriage had been present. Using a Clopper-Pearson confidence interval, we assumed that in order to confirm the symptom-checkers safety, the upper confidence bound should lie below 1%.
Results:
2543 patients were included in the study, 1227 (48.25%) female, 1316 (51.75%) male, 1397 (54.94) 18-49 y, 668 (26.27%) 50.65y, 360 (14.16%) 66-80y, 118 (4.64%) >80y. Of the 2543 cases none reached the pre-specified criterion for a potentially hazardous undertriage. This resulted in an upper 95% confidence bound for the probability of a potentially hazardous undertriage of 0.1184%.
Conclusions:
The symptom checker proved to be a safe triage tool, avoiding undertriage in a real-life clinical setting of emergency consultations at a WIC/ED. Our data suggest the symptom checker may be safely used in clinical routine. Clinical Trial: ClinicalTrials.gov (NCT04055298)
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