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New England Section of the American Urological Association

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Online Symptom Checker Accuracy in Diagnosing Menís Health Conditions
Rutul D. Patel, MBS1, Amanda R. Swanton, MD, PhD2, Martin S. Gross, MD2.
1New York Institute of Technology of Osteopathic Medicine, Old Westbury, NY, USA, 2Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

Introduction:
Many medical sites offer algorithm-based tools where patients can enter symptoms to receive potential diagnoses. The efficacy of these online symptom checkers (OSCs) in properly diagnosing male sexual health issues has not been explored. We analyzed the accuracy of the four most commonly used OSCs in diagnosing erectile dysfunction (ED), scrotal pain (SP), and Peyronieís disease (PD).
Methods:
Ninety artificial vignettes were created by deidentifying 30 patients each presenting to discuss ED, SP and PD. ED and PD were assessed because they are straightforward diagnoses. SP was selected because multiple potential diagnoses are possible. Vignettes were entered into the 4 most frequently used OSCs as determined by web traffic analysis. In order of use, these are WebMD (WMD), MedicineNet (MN), Everyday Health (EH) and Sutter Health (SH). The top 5 conditions listed in the OSC differential diagnosis were recorded. If less than 5 conditions were offered, the available conditions were recorded. Primary outcome was the accuracy of primary (Top 1) condition listed. Secondary outcome was frequency of the correct diagnosis appearing in the Top 3, or 5 of the suggested conditions.
Results:
WMD and EH did not correctly diagnose any of the ED or PD patients (Table 1) regardless of how many conditions were included in the differential. MN and SH offered the correct diagnoses for 100% of ED patients only when all of the Top 5 suggested conditions were included. Only MN offered the diagnosis of PD in its differential, and diagnosed the condition correctly in 100% of PD patients. On average, the OSCs had a higher success rate diagnosing ED than they did SP using Top 1 (37.5% vs. 9.17%), Top 3 (46.67% vs. 26.67%), and Top 5 (50% vs. 26.67%) of the suggested conditions. When including the top 5 conditions, MN was the most accurate OSC by correctly diagnosing 100% of the ED and PD cases, and 36.67% of the SP cases.
Conclusions:
WebMD, which receives nearly five times the web traffic of the next leading online symptom checker, and Everyday Health were both incapable of diagnosing ED and PD in this series. All OSCs were routinely poor at accurately suggesting causes of scrotal pain. Only MedicineNet was successful in diagnosing PD. Patients should be cautioned regarding the accuracy of OSCs.Table 1. Percent of cases correctly diagnosed as Top 1, 3, or 5 conditions of the differentials.

Online Symptom CheckerTop 1Top 3Top 5
EDPDSPEDPDSPEDPDSP
WebMD0%0%6.67%0%0%20%0%0%30%
MedicineNet90%100%10%100%100%23.33%100%100%36.67%
Everyday Health0%0%6.67%0%0%23.33%0%0%26.67%
Sutter Health60%0%13.33%86.67%0%26.67%100%0%26.67%
Mean37.5%25%9.17%46.67%25%23.33%50%25%30.00%


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