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Hand-Held Device Assists in Pulmonary Embolism Diagnosis

Computerized device improves adherence to evidence-based diagnostic guidelines, study finds

WEDNESDAY, Nov. 18 (HealthDay News) -- A hand-held, computerized clinical decision-support device can substantially improve adherence to guidelines and the accurate diagnosis of pulmonary embolism, according to a study in the Nov. 17 issue of the Annals of Internal Medicine.

Pierre-Marie Roy, M.D., of the Université d'Angers in France, and colleagues evaluated the use of the hand-held device in 20 French emergency departments, initially in a pre-intervention phase with 1,103 patients to gain familiarity, then in an intervention phase, in which 1,768 consecutive outpatients were randomized to diagnosis with the aid of either the device or diagnostic aids consisting of posters and pocket cards. Study outcomes included the accuracy of the diagnosis (diagnostic probability greater than 85 percent when embolism was ultimately confirmed or less than 5 percent when it was ruled out), adherence to diagnostic guidelines, and number of tests per patient.

The researchers found that more patients in both study groups were appropriately diagnosed in the intervention phase than in the pre-intervention phase. There was a 30.2 percent increase in appropriate diagnosis in the group using the hand-held device compared to 10.9 percent increase in the posters/pocket cards group. The improvement mainly consisted of accurately ruling out pulmonary embolism, and results varied between emergency departments.

"In summary, we show that the use of an electronic decision-support system available on handheld computers significantly improves diagnostic decision making for suspected pulmonary embolism in emergency departments," the authors write.

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