Study | Distribution of self-rated certainty | Scale for self-rating | Association between self-rating and process or outcome measures |
---|---|---|---|
AAP | Varied depending on diagnosis | VAS which ranged from 1 (total uncertainty) to 10 (total certainty) | Although surgeons were more certain about their diagnoses, they did not propose to use less imaging than trainees. Imaging recommended by both groups in 77% of patients, though it actually occurred in 84%. |
Boots | High confidence in 57%, medium in 25% and low in 18% | Clinical diagnostic confidence rated to one of three levels: high >50% likelihood, medium 20–50% likelihood and low <20% likelihood | High clinical confidence in pneumonia diagnosis was reported as an independent predictor for bronchoscopy (OR 2.19, CI 95% 1.29–3.72, p=0.004) although many factors were assessed in logistic regression. |
Bruyninckx | Dichotomised to binary scale (certain 1,673 vs uncertain 323) | Four-point categorical scale (certain, rather certain, rather uncertain or uncertain) | When certain, 65% of cases not referred. When uncertain, 29% of cases not referred. Urgent referral similar. Main difference in non-urgent referrals. |
Buntinx | Certain (33%), probable (41%), suspected (20%) and unknown (6%) | Four-point categorical scale (certain, probable, suspected or unknown) | An ECG was performed more frequently when the diagnosis was uncertain: 20% of patients with a certain diagnosis compared with 34% of patients whose diagnosis was only suspected. |
Davis | 41% of ratings were 9 or 10 while 12% of ratings 5 or less | Confidence scale from 1 to 10 | Not reported |
Green | 69% rated certainty and 31% rated uncertainty. For full diagram of distribution see Green SM, Martinez-Rumayor A, Gregory SA et al. Clinical uncertainty, diagnostic accuracy, and outcomes in emergency department patients presenting with dyspnea. Arch Intern Med 2008;168:741–8. | 0 to 100% scale of likelihood. Certainty estimate of either <20% or >80% was classified as clinical certainty, while estimates 21% to 79% were defined as clinical uncertainty | Patients judged uncertainly with respect to the presence or absence of acute heart failure were more likely to be admitted to the hospital, had a longer index hospital LOS, and had higher rates of 1-year morbidity and mortality, especially in those ultimately diagnosed as having acute heart failure. |
Lave | Unclear | VAS with hash marks at 0, 25, 50, 75 and 100 | Certainty rating was a significant factor accounting for variation in all measures of resource utilisation except adjusted pharmacy charges. |
McCullough | 47% rated low probability (0–20% likelihood), 28% rated intermediate probability (21–79% likelihood) and 25% rated high probability (80–100% likelihood) | 0 to 100% scale of likelihood. Certainty estimate of either <20% or >80% was classified as clinical certainty, while estimates 21% to 79% were defined as clinical uncertainty | Not reported |
Robaei | 14 ratings for score 1–2, 42 ratings for score 3–5, 12 ratings for score 6–7. For full diagram of distribution see Robaei D, Koe L, Bais R et al. Effect of NT-proBNP testing on diagnostic certainty in patients admitted to the emergency department with possible heart failure. Ann Clin Biochem 2011;48:212–7. | 1 to 7 scale (1 being high certainty diagnosis not heart failure and 7 being high certainty diagnosis is heart failure) | Not reported |
CI = confidence interval; ECG = electrocardiogram; LOS = length of stay; OR = odds ratio; VAS = visual analogue scale.