| Summary: | 碩士 === 臺中健康暨管理學院 === 健康管理研究所 === 93 === Clinician should be done the right medical decision under the limited of medical resource and prospect the patient’s rights and interests on recently. In deed, what’s clinical condition of a patient need to receive a medical examination or test is very difficult to decide it. If we can propose a medical diagnosis decision module under researched by evidence base to provide the clinician to make a right medical decision. It is not only to help the financial affairs of national insurance but also can give a good health system for the people in Taiwan. So the purpose of our research is to propose a medical diagnosis decision module via investigate the Hirschsprung disease. Hirschsprung disease is one kind of congenital gastrointestinal disease and it is very rare. The incidence was about one baby in five thousand live newborns. The disease is a congenital abnormality with an absence of parasympathetic ganglion cells in the affected segment of the rectum, recto-sigmoid, or other colon. The clinical manifestations are variable and common, such as abdominal distended, diarrhea, constipation, vomiting, or growth delay. How to diagnosis the disease is very difficult. Lower the sensitivity and specificity were noted in lower gastrointestinal radiography to diagnose the Hirschsprung disease. So far, the golden treatment for almost patient of Hirschsprung disease is surgery. So we evaluate the specificity and sensitivity of lower gastrointestinal radiograph to diagnosis of Hirschsprung Disease, and provide physician to make medical decision via the method of cost and effectiveness. This paper is a retrospective study. We enrolled 167 patients in this study and completed the questionnaire are 151 patients, those who consist of 62 male and 89 female and the competition rate is 89.92%. Those patients received the clinical diagnosis processing such as lower gastrointestinal radiography, rectal biopsy and long-term clinical follow up, than 26 patients were diagnosed of Hirschsprung disease. The sensitivity of lower gastrointestinal radiography is 0.769 and specificity is 0.464. From processing of medical decision and statistic logistic regression, we got tow formulas of logistic regression. R1-score=0.7717*the ratio of the largest colon’s diameter to the first vertebrae body+1.3251*transitional zone+1.8676*micro-colon - 0.375*age over 2 years old, R2score=0.7791* the ratio of the largest colon’s diameter to the first vertebrae body +1.2915*transitional zone+2.0064*micrcolon-0.2757* age over 2 years old -0.5603*radiography taken 24 hours after the study. We develop ROC curve of lower gastrointestinal radiography, can calculate the specificity and sensitivity from the operating point of the curve that can provide the clinician or radiologist to judge the examination. The likelihood ratio and the prevalence of the Hirschsprung disease are used to calculate the cost the benefit ratio at the operating point. Thus, knowledge of the costs and benefits of the lower gastrointestinal radiography can be used in conjunction with the results of a predictive value analysis to calculate the appropriate operating point for a test. We can get the result of sensitivity and specificity from that operating point. So gastroenterologist and radiologist can got a positive or negative diagnosis when the R1 or R2 value over the value of the threshold which is introduce the characters of lower gastrointestinal radiography into the formula R1 or R2. Additional they can know the sensitivity and the specificity of the lower gastrointestinal radiography when they use this method to diagnose the disease. This medical diagnosis module can provide clinician to do the right medical decision making for those suspect Hirschsprung disease.
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