Assessing Online Symptom Checker Accuracy in Diagnosing Men's Health Conditions

Abstract

ABSTRACT 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. Objective We analyzed the accuracy of the four most commonly used OSCs in diagnosing erectile dysfunction (ED), scrotal pain (SP), Peyronie's disease (PD), and low testosterone (LT). Methods One-hundred and sixty artificial vignettes were created by de-identifying recent initial outpatient consults presenting to discuss ED (40), SP (40), PD (40), and LT (40). ED and PD were selected for assessment because they were straightforward diagnosis. In contrast, SP and LT was selected because of varied etiologies and clinical presentations. The vignettes were entered into the 4 most frequently used OSCs as determined by web traffic analysis tools. The top 4 OSCs in order of use are WebMD (WMD), MedicineNet (MN), Everyday Health (EH) and Sutter Health (SH). The top 5 conditions listed in the OSC differential diagnosis were recorded and scored. If less than 5 conditions were offered, the available conditions were recorded and scored. The primary outcome was the accuracy of primary (Top 1) condition listed. The secondary outcome was frequency of the correct diagnosis appearing in the Top 3, or 5 of the suggested conditions. Results WMD did not offer the correct diagnosis for any ED or PD regardless of the number of conditions included from the differential vignettes (Table 1). However, WMD did successfully diagnose SP and LT in 22.5% and 95% of patients, respectively. Comparatively, EH was only able to diagnose SP 20% of the time, and failed to diagnose ED, PD, or LT on all occasions. MN successfully diagnosed ED, PD, SP, and LT in 100%, 98%, 27.5%, and 0% of patients, respectively. On average, MN was the most accurate OSC when including Top 1 (48.25%), Top 3 (53.88%), and Top 5 (56%) suggested conditions. Lastly, SH saw the largest overall improvement in accuracy when using the Top 5 suggested conditions compared to Top 1 (50% vs. 18%). SH correctly diagnosed ED, SP, and LT in 100%, 20%, and 80% of patients, respectively. The OSCs were most accurate diagnosing ED and least accurate diagnosing SP when using the Top 1 (37.5% vs. 6.88%), Top 3 (47.5% vs. 17.5%) and Top 5 (50% vs. 24.5%) of the suggested conditions. 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. Only MedicineNet offered diagnoses for PD. All OSCs were routinely poor at suggesting precise diagnoses for scrotal pain, even when including 5 potential options in the differential. LT was only diagnosed by WMD and SH. Patients should be cautioned regarding the accuracy of OSCs. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast