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Objective medical decision making acute abdominal pain


To provide optimised diagnostic clinical data concerning patients admitted to hospital with abdominal pain.
To determine the accuracy with which diagnostic decisions can be made using such data.
To define the uncertainty remaining after their use.
To determine the contribution of the technologies used to the reduction of the residual uncertainty.
The project has dealt with objective medical decision making in relation to acute abdominal pain. Over 450 clinicians and scientists in 64 institutions in 19 different countries have participated in a network of collaborating centres, along with input from 18 national and international societies. Agreement has been reached concerning a minimum dataset of information to be collected from patients presented to hospital with acute abdominal pain, together with definitions of terminology for each clinical feature and criteria for diagnosis of each specific disease. On this basis a proforma has been developed and translated into most major European languages for the purposes of quality controlled, reproducible data collection. Clinical information concerning 15000 acute abdominal pain cases has been collected.

Immediate benefits have occurred within the institutions participating in the project. There is evidence that institutions associated with the project have (when compared with unaided baseline or national figures) achieved the following benefits: reduction of residual diagnostic error rate by 40%; reduction in unnecessary operation rate by two fifths; reduction in preforation rate in appendicitis cases by half.

Longer term benefits are now available for the European Community (EC) in terms of: the existence of an agreed reproducible terminology for acute abdominal pain; the creation of a language independent computer program to aid objective medical decision making and clinical audit; the development of an EC wide multinational research team from groups of scattered workers; the creation and distribution of decision support materials, structured proformata, teaching videotapes and computer programs widely throughout the EC; the availability of a database of information, strictly controlled for quality, for further clinical research and for evaluation of further decision support technology in the future.
Detailed Goals

1. To develop, (by consultation with individual surgeons and national associations in participating countries) agreed lists of disease categories, and indicant categories; together with agreed definitions of terminology involved.

2. To develop (by similar consultation) an agreed instrument for data collection.

3. To collect (prospectively by use of the above instrument) data concerning not less than 10,000 cases presenting to hospital with acute abdominal pain of less than one week's duration (so as to include at least 100 cases of all diseases whose incidence is more than 0.9%).

4. To circulate, amongst participants, the data collected via a communications network involving EUROKOM and MS-DOS technology.

5. To collate the resultant information into a database to be placed into the public domain.

6. To monitor diagnostic accuracy in each centre, both at initial contact, and after 'conventional' investigations; by comparing each diagnosis with the 'final' diagnosis (after discharge from hospital).

7. To analyse each case via OMDM techniques and compare this prediction also with the final diagnosis after discharge.

8. To study the impact of the 'EC database' upon the accuracy of OMDM predictions.

9. To evaluate and report upon, the potential impact of this activity upon OMDM, clinical care, and society within the EC.


University of Leeds
22 Hyde Terrace
LS2 9LN Leeds
United Kingdom