The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review

Abstract

Digital and online symptom checkers are an increasingly adopted class of health technologies that enable patients to input their symptoms and biodata to produce a set of likely diagnoses and associated triage advice. However, concerns regarding the accuracy and safety of these symptom checkers have been raised. This systematic review evaluates the accuracy of symptom checkers in providing diagnoses and appropriate triage advice. MEDLINE and Web of Science were searched for studies that used either real or simulated patients to evaluate online or digital symptom checkers. The primary outcomes were the diagnostic and triage accuracy of the symptom checkers. The QUADAS-2 tool was used to assess study quality. Of the 177 studies retrieved, 10 studies met the inclusion criteria. Researchers evaluated the accuracy of symptom checkers using a variety of medical conditions, including ophthalmological conditions, inflammatory arthritides and HIV. A total of 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low across included studies (range: 19–37.9%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8–90.1%) was typically higher than diagnostic accuracy. Overall, the diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasing push towards adopting this class of technologies across numerous health systems, this study demonstrates that reliance upon symptom checkers could pose significant patient safety hazards. Large-scale primary studies, based upon real-world data, are warranted to demonstrate the adequate performance of these technologies in a manner that is non-inferior to current best practices. Moreover, an urgent assessment of how these systems are regulated and implemented is required.

The Diagnostic Efficacy of an App-based Diagnostic Health Care Application in the Emergency Room: eRadaR-Trial. A prospective, Double-blinded, Observational Study

“…7,24,[29][30][31] The most recent review of Wallace et al including 10 studies exhibited an overall primary diagnostic accuracy ranging only from 19% to 38% and from 33% to 58% for the top 3 diagnose. 32 These systematic reviews together with the findings of our study show, that physicians vastly outperformed computerized algorithm-based diagnostic tools, thus, remaining the gold standard for clinical decision-making. However, despite physicians' superior performance, they still provide inaccurate diagnoses in approximately 20% of cases, similar to prior estimated diagnostic error rates of physicians (10%-15%).…”

WtsWrng Interim Comparative Effectiveness Evaluation and Description of the Challenges to Develop, Assess, and Introduce This Novel Digital Application in a Traditional Health System

“…Conversely, others mention that it is not clear if the increase in demand of services observed may be due to the emergence of an unmet need or a supply-induced demand [ 56 ]. A specific study to test the impact of WW in decreasing demand and improving efficiency in healthcare resource use in a large real-life study, as suggested by some authors [ 57 ], is already planned.…”

Triage and Diagnostic Accuracy of Online Symptom Checkers: Systematic Review (Preprint)

“…The evidence was assessed as being mostly weak and insufficient to determine the level of safety of digital and online symptom checkers for patients. More recently, Wallace et al [7] published a systematic review on the diagnostic and triage accuracy of OSCs, including speciality-specific tools but searching only Medline and Web of Science up to 15 February 2021. Both triage and diagnostic accuracy of OSCs were found to be mostly low despite variations.…”

“…If inadequately designed, they could misdiagnose and/or misdirect users potentially diverting the user from seeking adequate care or conversely placing additional strain on health systems. Two systematic reviews assessed the literature evaluating OSCs [7,8] with mostly weak evidence regarding their diagnostic and triage accuracy. One review focused only on urgent health issues, while the other included speciality-specific OSCs, and both were outdated following the recent publication of several eligible studies.…”