Assessment of the severity of asthma by an expert system. Description and evaluation.

Abstract

Asthmaexpert, an expert system (ES), was produced at the special request of several clinicians in order to better understand the medical decisions made clinical experts in managing an asthmatic patient. We describe and evaluate this knowledge base, focusing mainly on assessment of the severity of asthma. After compiling data from a patient, Asthmaexpert assesses the severity of the disease and identifies the trigger factors involved, suggests any further investigations that may be required, and offers a treatment strategy. Implemented with Nexpert and Hypercard, it runs on a MacIntosh personal computer. The validation stage involved eight clinical experts who provided 20 case report forms (CRF) with their conclusions about management of asthma. The CRF were then programmed into the ES, which provided its own conclusions about the same subjects. Afterward, all the experts evaluated the conclusions given by ES or by their colleagues in a double-blind manner. One hundred twenty-seven CRF were available. The reliability of the experts' opinions was good, with a substantial consensus between them when assessing severity scores (kappa = 0.27 to 0.54). There was no difference in concordance of opinions on severity scores either between the experts who designed the system and ES or between the other experts and ES (weighted kappa = 0.72 and 0.69, respectively). Experts judged that the severity scores given by ES were as good as those proposed by their colleagues, and that the overall conclusions given by ES were as good as or better than those given by their colleagues. The conclusions drawn by ES were given a good rating.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of variations in control of asthma over time

“…The case-report form used to validate the expert system [13] allowed recording of data at successive follow-up visits. The data reflect the real activity of a hospital asthma visit, with patients returning at variable intervals according to their perceived needs.…”

“…The expert system has been described in detail elsewhere [13]; it consists of a case database, a knowledge base and an inferential driver. The expert system generates a variety of conclusions, including, in particular, asthma severity, which was based on symptoms and medication needs according to international and various national consensus [5].…”

“…In 1995, the present authors9 developed an "expert system" to appreciate the natural history of asthma [13]. During the validation of this system, it became apparent that it was difficult to consider the total asthmatic population as a whole.…”

Comparison of an expert system with other clinical scores for the evaluation of severity of asthma

“…The tool exists, and the program has been implemented on a MacIntosh computer. The conclusions are relevant and the system has been validated [23,33]. The formalization of this knowledge has made it possible to obtain a first level of consensus.…”

“…Asthmaexpert has been described previously [23]. Briefly, the knowledge base was established by several expert chest physicians in regular contact with a knowledge engineer.…”