Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

HSR&D Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Chartan C, Singh H, Krishnamurthy P, Sur M, Meyer A, Lutfi R, Stark J, Thammasitboon S. Isolating red flags to enhance diagnosis (I-RED): An experimental vignette study. International journal for quality in health care : journal of the International Society for Quality in Health Care. 2019 Oct 31; 31(8):G97-G102.
PubMed logo Search for Abstract from PubMed
(This link leaves the website of VA HSR&D.)

Abstract: OBJECTIVE: To investigate effects of a cognitive intervention based on isolation of red flags (I-RED) on diagnostic accuracy of ''do-not-miss diagnoses.'' DESIGN: A 2 × 2 randomized case vignette-based experiment with manipulation of I-RED strategy between subjects and case complexity within subjects. SETTING: Two university-based residency programs. PARTICIPANTS: One-hundred and nine pediatric residents from all levels of training. INTERVENTIONS: Participants were randomly assigned to the I-RED vs. control group, and within each group, they were further randomized to the order in which they saw simple and complex cases. The I-RED strategy involved an instruction to look for a constellation of symptoms, signs, clinical data or circumstances that should heighten suspicion for a serious condition. MAIN OUTCOME MEASURES: Primary outcome was diagnostic accuracy, scored as 1 if any of the three differentials given by participants included the correct diagnosis, and 0 if not. We analyzed effects of I-RED strategy on diagnostic accuracy using logistic regression. RESULTS: I-RED strategy did not yield statistically higher diagnostic accuracy compared to controls (62 vs. 48%, respectively; odd ratio  =  2.07 [95% confidence interval, 0.78-5.5], P  =  0.14) although participants reported higher decision confidence compared to controls (7.00 vs. 5.77 on a scale of 1 to 10, P  <  0.02) in simple but not complex cases. I-RED strategy significantly shortened time to decision (460 vs. 657 s, P  <  0.001) and increased the number of red flags generated (3.04 vs. 2.09, P  <  0.001). CONCLUSIONS: A cognitive strategy of prompting red flag isolation prior to differential diagnosis did not improve diagnostic accuracy of ''do-not-miss diagnoses.'' Given the paucity of evidence-based solutions to reduce diagnostic error and the intervention''s potential effect on confidence, findings warrant additional exploration.

Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.