Computer-assisted diagnosis in gastroenterology.

During the last 20 years, Danish gastroenterologists and biostatisticians have been involved in practical and theoretical research aimed at providing computer-assisted decision support in clinical practice. On the practical side, we summarize two clinical applications, one in the acute abdomen, the other in jaundice. The former project is part of a worldwide effort which appears able to reduce considerably the perforated appendix rate and the negative laparotomy rate. In the latter project, also entwined in international activities, three methods of early statistical discrimination of jaundice causes have been tested, and it has been shown how ultrasonographic data can be incorporated into the diagnostic assessment. On the theoretical side, a Dutch-Danish group has been looking into how one best designs a trial and analyses its data in the context of measuring the quality and impact of machine-made diagnostic advice. Having pointed out the international ramifications of these activities, we outline what may lie ahead: Gastroenterologists must be prepared to join large-scale field trials of clinical advice-giving software. In the future, however, such software will often become embedded in general hospital recordkeeping systems.