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Automation bias in medicine: The influence of automated diagnoses on interpreter accuracy and uncertainty when reading electrocardiograms

  • Introduction: Interpretation of the 12‑lead Electrocardiogram (ECG) is normally assisted with an automated diagnosis (AD), which can facilitate an ‘automation bias’ where interpreters can be anchored. In this paper, we studied, 1) the effect of an incorrect AD on interpretation accuracy and interpreter confidence (a proxy foruncertainty), and 2) whether confidence and other interpreter features can predict interpretation accuracy using machine learning. Methods: This study analysed 9000 ECG interpretations from cardiology and non-cardiology fellows (CFs and non-CFs). One third of the ECGs involved no ADs, one third with ADs (half as incorrect) and one third had multiple ADs. Interpretations were scored and interpreter confidence was recorded for each interpretation and subsequently standardised using sigma scaling. Spearman coefficients were used for correlation analysis and C5.0 decision trees were used for predicting interpretation accuracy using basic interpreter features such as confidence, age, experience and designation.Introduction: Interpretation of the 12‑lead Electrocardiogram (ECG) is normally assisted with an automated diagnosis (AD), which can facilitate an ‘automation bias’ where interpreters can be anchored. In this paper, we studied, 1) the effect of an incorrect AD on interpretation accuracy and interpreter confidence (a proxy foruncertainty), and 2) whether confidence and other interpreter features can predict interpretation accuracy using machine learning. Methods: This study analysed 9000 ECG interpretations from cardiology and non-cardiology fellows (CFs and non-CFs). One third of the ECGs involved no ADs, one third with ADs (half as incorrect) and one third had multiple ADs. Interpretations were scored and interpreter confidence was recorded for each interpretation and subsequently standardised using sigma scaling. Spearman coefficients were used for correlation analysis and C5.0 decision trees were used for predicting interpretation accuracy using basic interpreter features such as confidence, age, experience and designation. Results: Interpretation accuracies achieved by CFs and non-CFs dropped by 43.20% and 58.95% respectively when an incorrect AD was presented (p b 0.001). Overall correlation between scaled confidence and interpretation accuracy was higher amongst CFs. However, correlation between confidence and interpretation accuracy decreased for both groups when an incorrect AD was presented. We found that an incorrect AD disturbs the reliability of interpreter confidence in predicting accuracy. An incorrect AD has a greater effect on the confidence of nonCFs (although this is not statistically significant it is close to the threshold, p = 0.065). The best C5.0 decision tree achieved an accuracy rate of 64.67% (p b 0.001), however this is only 6.56% greater than the noinformation-rate. Conclusion: Incorrect ADs reduce the interpreter's diagnostic accuracy indicating an automation bias. Non-CFs tend to agree more with the ADs in comparison to CFs, hence less expert physicians are more effected by automation bias. Incorrect ADs reduce the interpreter's confidence and also reduces the predictive power of confidence for predicting accuracy (even more so for non-CFs). Whilst a statistically significant model was developed, it is difficult to predict interpretation accuracy using machine learning on basic features such as interpreter confidence, age, reader experience and designation.show moreshow less

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Metadaten
Author:Daniel GüldenringORCiD, Raymond R. BondORCiD, Tomas Novotny, Irena Andrsova, Lumir Koc, Martina Sisakova, Dewar D. FinlayORCiD, James D. McLaughlinORCiD, Aaron Peace, Victoria McGilligan, Stephen J. Leslie, Hui Wang, Marek Malik
DOI:https://doi.org/10.1016/j.jelectrocard.2018.08.007
Identifier:0022-0736 OPAC HS OPAC extern
Parent Title (English):Journal of Electrocardiology
Publisher:Elsevier
Place of publication:New York
Document Type:Article
Language:English
Date of Publication (online):2018/08/10
Year of first Publication:2018
Tag:Biomedizinische Signalverarbeitung; EKG
ECG
Volume:51
Issue:6
Number of pages:6 Seiten
First Page:6
Last Page:11
Institutes:Fakultät Elektrotechnik
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften
Publication Lists:Güldenring, Daniel
Publication reviewed:begutachtet
Release Date:2021/02/15
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