Key result
Automated decision support matches manual CHA2DS2-VASc scoring with moderate agreement while cutting calculation time ~77%.
Why the study?
Clinical decision support systems are advocated to improve healthcare quality and efficiency, but validation is needed prior to implementation.
Does an automated clinical decision support system calculate CHA2DS2-VASc scores as accurately and efficiently as manual calculation by physicians in patients with atrial rhythm disturbances?
Observational (n=224)
None
No
Does an automated clinical decision support system calculate CHA2DS2-VASc scores as accurately and efficiently as manual calculation by physicians in patients with atrial rhythm disturbances?
An automated clinical decision support system calculates CHA2DS2-VASc scores more efficiently and with fewer errors than manual calculation by physicians.
Answers are grounded in this paper and cite their sources.
May expedite CHA2DS2-VASc scoring; leaves open accuracy for routine use pending prospective validation.
Background and Objectives: Clinical decision support systems are advocated to improve the quality and efficiency in healthcare. However, before implementation, validation of these systems needs to be performed. In this evaluation we tested our hypothesis that a computerized clinical decision support system can calculate the CHA2DS2-VASc score just as well compared to manual calculation, or even better and more efficiently than manual calculation in patients with atrial rhythm disturbances. Materials and Methods: In n = 224 patents, we calculated the total CHA2DS2-VASc score manually and by an automated clinical decision support system. We compared the automated clinical decision support system with manually calculation by physicians. Results: The interclass correlation between the automated clinical decision support system and manual calculation showed was 0.859 (0.611 and 0.931 95%-CI). Bland-Altman plot and linear regression analysis shows us a bias of −0.79 with limit of agreement (95%-CI) between 1.37 and −2.95 of the mean between our 2 measurements. The Cohen’s kappa was 0.42. Retrospective analysis showed more human errors than algorithmic errors. Time it took to calculate the CHA2DS2-VASc score was 11 s per patient in the automated clinical decision support system compared to 48 s per patient with the physician. Conclusions: Our automated clinical decision support system is at least as good as manual calculation, may be more accurate and is more time efficient.
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Giersbergen et al. (2022) conducted an observational in Atrial rhythm disturbances (n=224). Automated clinical decision support system (aCDSS) vs. Manual calculation by physicians (mCDSS) was evaluated on Accuracy of automatically calculated CHA2DS2-VASc score compared to manual calculation (intraclass correlation) (ICC 0.859, 95% CI 0.611-0.931). An automated clinical decision support system demonstrated moderate agreement (ICC 0.859) with manual calculation for CHA2DS2-VASc scores, while reducing average calculation time from 48 to 11 seconds.
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