“The Wells and revised Geneva scores can be approximated with high accuracy through the automated extraction of structured EHR data elements in patients who underwent CTPA in the emergency department.”
Can it be done? Can the computer automatically discern your intent and extract pulmonary embolism risk-stratification from the structured data? And, with “high accuracy” as these authors tout in their conclusion?
IFF: “High accuracy” means ~90%. That means one out of every ten in their sample was misclassified as low- or high-risk for PE. This is clinically useless.
The Wells classification, of course, depends highly upon the 3 points assigned for “PE is most likely diagnosis.” So, these authors assigned 3 points positive for every case. This sort of probably works in a population that was selected explicitly because they underwent CTPA in the ED, but is obviously a foundationally broken kludge. Revised Geneva does not have a “gestalt” element, but there are still subjective examination features that may not make it into structured data – and, obviously, it performed just as well (poorly) as the Wells tool.
To put it mildly, these authors are overselling their work a little bit. The electronic health record will always depend on the data entered – and it’s setting itself up for failure if it depends on specific elements entered by the clinician contemporaneously during the evaluation. Tools such as these have promise – but perhaps not this specific application.
“Automated Pulmonary Embolism Risk Classification and Guideline Adherence for Computed Tomography Pulmonary Angiography Ordering”
https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13442