RUDN Journal of MedicineRUDN Journal of MedicineВестник Российского университета дружбы народов. Серия: Медицина2313-02452313-0261Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)3510010.22363/2313-0245-2023-27-2-228-245FVUUDASURGERYХИРУРГИЯResearch ArticleEvaluation of the efficiency of the expert medical decision making system in diagnosis acute appendicitisОценка эффективности экспертной системы принятия врачебных решений в диагностике острого аппендицитаhttps://orcid.org/0000-0003-3427-44837831-2673BurnevichSlavomir Z.БурневичС. З.burnslavomir@mail.ruhttps://orcid.org/0009-0006-4034-8767MaslenkoNikita S.МасленкоН. С.burnslavomir@mail.ruCity Clinical Hospital named after V.V. VinogradovГородская клиническая больница имени В.В. Виноградова29062023272CARDIOVASCULAR DISEASESЗАБОЛЕВАНИЯ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ22824529062023Copyright ©; 2023, Burnevich S.Z., Maslenko N.S.Copyright ©; 2023, Бурневич С.З., Масленко Н.С.2023Burnevich S.Z., Maslenko N.S.Бурневич С.З., Масленко Н.С.https://creativecommons.org/licenses/by-nc/4.0https://journals.rudn.ru/medicine/article/view/35100

Relevance. Timely diagnosis is the basic criterion for the quality of medical care in emergency department. One of the promising directions in the prevention of diagnostic errors is the use in clinical practice of the expert decision support system (EDSS). The aim of this study was a comparative analysis of the diagnostic efficiency of EDSS in acute appendicitis (AA) at various stages of the differential diagnosis of acute abdominal pain (AAP). Materials and methods. The study performed a retrospective analysis of the diagnostic results of 150 patients with various forms of AA, followed by the processing of structured clinical, laboratory and instrumental data using the original version of EDSS. Results and Discussion. It has been established that EDSS unidirectionally and sequentially models the stages of a standard diagnostic program for examining a patient with AAP at all levels of automated assessment of symptoms and signs of AA. Depending on the final parameters of the indication, the EDSS makes it possible to differentiate the variants of AA clinical scenarios with the identification of categories of diagnostic complexity that occurred in surgical practice. The data of relevance and validity of EDSS in the differential diagnosis of AAP are presented. The role of the expert system for the intensification of the doctor’s clinical reasoning and the prevention of diagnostic errors in emergency abdominal surgery is noted. Conclusion. The data obtained indicate a comparable diagnostic efficiency of the proposed version of EDSS with the accuracy of the diagnosis of a surgeon. The results of the preclinical use of EDSS allow the clinician to recommend its use in the format of an interactive “cognitive assistant” in case of possible difficulties and doubts in the differential diagnosis of AAP.

Актуальность. В отделениях неотложной хирургии своевременная диагностика является базовым критерием качественного оказания медицинской помощи. Одним из перспективных направлений в предупреждении диагностических ошибок рассматривается применение в клинической практике экспертных систем поддержки принятия врачебных решений (ЭСППВР). Целью настоящего исследования является сравнительное изучение диагностической эффективности ЭСППВР при остром аппендиците (ОА) на различных этапах дифференциальной диагностики острых заболеваний органов брюшной полости (ОЗОБП). Материалы и методы. В исследовании выполнен ретроспективный анализ результатов диагностики 150 пациентов с различными формами ОА с последующей обработкой структурированных клинических, лабораторных и инструментальных данных с помощью оригинальной версии ЭСППВР. Результаты и обсуждения. Установлено, что на всех уровнях автоматизированной оценки симптомов и признаков ОА ЭСППВР однонаправленно и последовательно моделирует этапы стандартной диагностической программы обследования пациента с болями в животе. В зависимости от итоговых параметров индикации ЭСППВР позволяет дифференцировать варианты клинических проявлений ОА с идентификацией категорий сложности диагностики, имевшей место в хирургической практике. Приводятся данные релевантности и валидности ЭСППВР при дифференциальной диагностике ОЗОБП. Отмечается роль экспертной системы для интенсификации клинических рассуждений врача и предупреждения диагностических ошибок в неотложной абдоминальной хирургии. Выводы. Полученные данные свидетельствуют о сравнимой диагностической эффективности предлагаемой версии ЭСППВР с точностью диагностики врача-хирурга. Результаты доклинического использования ЭСППВР позволяют рекомендовать клиницисту ее применение в формате интерактивного «когнитивного помощника» при возможных затруднениях и сомнениях в дифференциальной диагностике ОЗОБП.

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