Systematic reviews of decision tools for acute abdominal pain
Joseph Liu, Jon Deeks and Doug Altman with Jeremy Wyatt (National Institute of Clinical Excellence & Oxford), Justin Keen (Leeds), Martin Dawes (McGill), Christian Ohmann (Düsseldorf), Susan Clamp (Leeds), James Wellwood (London), and Pablo Verde (Düsseldorf and Dortmund)
The accurate diagnosis of acute abdominal pain (AAP) is difficult, in both primary and secondary care, because many conditions cause it and no single clinical finding or laboratory test is both specific and sensitive. As a result, many decision tools which combine two or more clinical or laboratory findings have been developed to aid the management of AAP. While some appear more accurate than junior doctors, there is no clear consensus on which, if any, tool is most appropriate for use by UK general practitioners or hospital doctors. This study was commissioned by the NHS R&D’s Health Technology Assessment programme to assess whether and by much decision tools improve the clinical management of AAP. The study addresses the following questions:
1. What are the diagnostic accuracies of AAP decision tools and unaided doctors’ decisions?
2. What are the impacts of providing doctors with AAP decision tools on patient outcomes, clinical decisions, actions and use of healthcare resources?
3. What are the usage rates and ease of use of each decision tool?
4. What are the associated costs and likely cost-effectiveness of these decision tools in routine use in the UK?
Systematic reviews and other secondary research methods were used to answer the above questions. The study findings are expected to help i) improve GP referral, hospital admission and surgical decisions, ii) enhance patient outcomes and iii) facilitate more appropriate NHS resource use.
Additional outputs of the project will include a set of reporting guidelines for decision support systems along the lines of CONSORT and STARD.
