The nature and usefulness of patient experience information in producing guidance about interventional procedures.

OBJECTIVES: To evaluate the nature of patient experience input and its perceived usefulness to members of a national Advisory Committee in making decisions about the efficacy and safety of new interventional procedures. DESIGN: Survey of Advisory Committee members about the nature and usefulness of patients' responses to a patient experience semistructured questionnaire. SETTING: Interventional Procedures Programme, NICE. PARTICIPANTS: 16 Committee members who assessed responses to 73 patient experience questionnaires. MAIN OUTCOME MEASURES: Judged nature and usefulness of patient responses to different questions about the experience of patients in using one of nine different procedures. FINDINGS: Most patient responses were scored as useful: <20% were scored as 'unhelpful' or 'very unhelpful.' Committee members felt that patient responses most often supported other evidence but provided no new insights (52-68% of responses for 11 of the 12 questions). Responses to one question (effects of the procedure on specified areas of life) gave new and original evidence which was not present in the literature or expert opinions in 7% cases. Responses to eight of the 12 questions provided insights into sociocultural or equalities issues in 1-7% of cases. CONCLUSIONS: Obtaining patient experience to inform guidance development is complex but provides generally useful supporting evidence and some new insights not available from other evidence. Further research should aim to further develop and validate different methods to obtain patient experience input. The impact of patient experience information on how the Committee decides about whether a procedure is efficacious and/or safe should be made explicit.

Dating of bruises in children: an assessment of physician accuracy.

OBJECTIVE: To determine whether physicians can estimate accurately the age of an accidental bruise on direct physical examination. METHODS: Children who presented to the emergency department of a children's hospital with accidental bruises of known age and origin had demographic data and information about their injury recorded. History-blinded emergency pediatricians, other physicians, and trainees (fellows, residents, and medical students) independently examined the bruised area and recorded injury characteristics and age estimation and ranked characteristics that influenced their estimation. RESULTS: Fifty children with accidental bruises were enrolled. Emergency pediatricians' accuracy of age estimation within 24 hours of actual age was 47.6%. Individual emergency pediatrician's accuracy ranged from 0% to 100%, and the interobserver reliability was poor (kappa = -0.03). Accuracy within 24 hours of actual age was 29.4% for other physicians and 36.8% for trainees, which was similar to the emergency pediatricians. Observers reported using color primarily to estimate age, followed by tenderness and then swelling; however, none of these factors was significantly correlated with accuracy. CONCLUSIONS: Physician estimates of bruise age are highly inaccurate within 24 hours of the actual age of the injury. Large individual variability and poor interrater reliability also suggest that caution must be used when interpreting these estimates. This study supports earlier studies, urging extreme caution in estimating bruise age, even when such estimates are based on direct examination of the injured area.