Is self-triage by patients using a symptom-checker safe?

Andreas Meer, Jacopo Demurtas

Keywords: triage, safety, telemedicine, symptom checkers

Background:

Symptom-Checker-Apps have recently come on the market, helping users with self-triage through an interactive medical assessment and providing guidance on the urgency of the clinical picture presented. To be safe and effective, this tools should identify the right time to treat and point of care, avoiding potential situations of hazardous undertriage.

Research questions:

What is the probability of an undertriage to result in a risk to life or health (potentially hazardous undertriage) for patients using a symptom-checker?

Method:

Single-centered, prospective, non-randomized, non-placebo-controlled clinical trial comparing the patient’s self-triage using the Symptom Checker, with the assessment of the urgency made by three interdisciplinary panels of physicians (panel A, B and C).
The assessment of the urgency encompassed the appropriate time-to-treat (T2T) and the adequate point-of-care (PoC). Cases which were adjuged to be undertriaged by panel A and B, were assessed for a risk to health or life by panel C.
Potentially hazardous undertriage was defined as a case where panel C reaches a consensus that it is “rather likely” or “likely” that the self-triage could have led to a hazardous undertriage.
To analyze it, Clopper-Pearson confidence bound was chosen. We assumed that in order to confirm the Symptom-Checkers safety, the upper confidence bound should lie below 1%.

Results:

Of the 2529 cases available for the analysis, none reached the pre-specified criterion for a potentially hazardous undertriage. This resulted in an upper 95% confidence bound for the probability of a potentially hazardous undertriage of 0.1184%

Conclusions:

Using the available data symptom-checkers’s safety seems to be confirmed. Further studies aimed at investigating the risk of overtriage and its consequences are ongoing.

Points for discussion:

Safety and effectiveness of triage-oriented symptom-checkers

Potential role of self-triage in organization of care

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