Diagnostic algorithm allows for a scientifically robust and reliable retrospective diagnosis using textual evidence from mid-19th century Basel, Switzerland

IF 1.3 3区 地球科学 Q3 PALEONTOLOGY
Wolfgang Krüger
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引用次数: 0

Abstract

Objective

Diagnosing disease from the past using historic textual sources can be controversial as to its accuracy. To overcome these objections, an empirical approach to the historical clinical data was developed. The approach follows a standardised, objective, and systematic evaluation, satisfying the requirements of the philosophy of science.

Material

Physician-managed medical records of mid-19th century patients reported to have suffered from tuberculosis.

Method

A diagnostic algorithm, quantifying clinical data into a scoring system, was developed based on criteria recorded in the medical sources. The findings were compared to the autopsy results using the Receiver Operating Characteristics method.

Results

The generated scoring system correctly predicted the diagnosis of tuberculosis in 86% of patients in the study. 6% false negatives and 8% false positives were predicted.

Conclusions

It is possible to retrospectively diagnose in a reliable and scientifically robust manner under certain conditions. It is important to embed the clinical data into the historical context. A general rejection of retrospective diagnosis is unsubstantiated. Well-designed, disease-specific, and source adapted medical scoring systems are new approaches and overcome criticism raised against retrospective diagnosis.

Significance

This new approach utilises diverse historic sources and potentially leads to reliable retrospective diagnosis of most common diseases of the past.

Limitations

Selection bias of the records allocated. Quality of the historic sources utilized. Restricted statistical assessment potential of historic sources.

Suggestions for further research

Development of disease- and epoch-specific medical score systems.

诊断算法可利用 19 世纪中期瑞士巴塞尔的文字证据进行科学可靠的回顾性诊断
目的利用历史文本资料诊断过去的疾病,其准确性可能会引起争议。为了克服这些异议,我们开发了一种对历史临床数据进行实证分析的方法。该方法遵循标准化、客观和系统化的评估,符合科学哲学的要求。方法根据医学资料中记录的标准,开发了一种诊断算法,将临床数据量化为一个评分系统。结果所生成的评分系统正确预测了研究中 86% 患者的肺结核诊断结果。结论在一定条件下,以可靠、科学的方式进行回顾性诊断是可行的。重要的是要将临床数据纳入历史背景。普遍反对回顾性诊断是没有根据的。精心设计的、针对特定疾病的、与资料来源相适应的医学评分系统是一种新方法,可以克服对回顾性诊断提出的批评。意义这种新方法利用不同的历史资料来源,有可能对过去大多数常见疾病进行可靠的回顾性诊断。利用的历史资料的质量。进一步研究的建议开发针对特定疾病和时代的医疗评分系统。
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来源期刊
CiteScore
2.90
自引率
25.00%
发文量
43
期刊介绍: Paleopathology is the study and application of methods and techniques for investigating diseases and related conditions from skeletal and soft tissue remains. The International Journal of Paleopathology (IJPP) will publish original and significant articles on human and animal (including hominids) disease, based upon the study of physical remains, including osseous, dental, and preserved soft tissues at a range of methodological levels, from direct observation to molecular, chemical, histological and radiographic analysis. Discussion of ways in which these methods can be applied to the reconstruction of health, disease and life histories in the past is central to the discipline, so the journal would also encourage papers covering interpretive and theoretical issues, and those that place the study of disease at the centre of a bioarchaeological or biocultural approach. Papers dealing with historical evidence relating to disease in the past (rather than history of medicine) will also be published. The journal will also accept significant studies that applied previously developed techniques to new materials, setting the research in the context of current debates on past human and animal health.
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