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Acute Respiratory FailureNCT06098950

Human Algorithm Interactions for Acute Respiratory Failure Diagnosis

A study testing Artificial Intelligence model predictions without explanation, Artificial intelligence model predictions with explanation and AI model biased against heart failure in people with Acute Respiratory Failure, run by University of Michigan at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Artificial intelligence (AI) shows promising in identifying abnormalities in clinical images. However, systematically biased AI models, where a model makes inaccurate predictions for entire subpopulations, can lead to errors and potential harms. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Acute Respiratory Failure
What is being tested?
Artificial Intelligence model predictions without explanation, Artificial intelligence model predictions with explanation and AI model biased against heart failure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
457 participants
Where
1 siteUnited States
Study dates
1 Apr 2022to 31 Jan 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Physicians, nurse practitioners, and physician assistants that care for patients with acute respiratory failure as part of their clinical practice

Who cannot join

  • Physicians, nurse practitioners, and physician assistants that only provide patient care in outpatient settings

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Michigan

    Ann Arbor, Michigan, 48103

Other trials in United States

About this study

Official title: Measuring the Impact of AI in the Diagnosis of Hospitalized Patients: A Randomized Survey Vignette Multicenter Study

Artificial intelligence (AI) shows promising in identifying abnormalities in clinical images. However, systematically biased AI models, where a model makes inaccurate predictions for entire subpopulations, can lead to errors and potential harms. When shown incorrect predictions from an AI model, clinician diagnostic accuracy can be harmed. This study aims to study the effectiveness of providing clinicians with image-based AI model explanations when provided AI model predictions to help clinicians better understand the logic of an AI model's prediction. It will evaluate whether providing clinicians with AI model explanations can improve diagnostic accuracy and help clinicians catch when models are making incorrect decisions. As a test case, the study will focus on the diagnosis of acute respiratory failure because determining the underlying causes of acute respiratory failure is critically important for guiding treatment decisions but can be clinically challenging.

To determine if providing AI explanations can improve clinician diagnostic accuracy and alleviate the potential impact of showing clinicians a systematically biased AI model, a randomized clinical vignette survey study will be conducted. During the survey, study participants will be shown clinical vignettes of patients hospitalized with acute respiratory failure, including the patient's presenting symptoms, physical exam, laboratory results, and chest X-ray. Study participants will then be asked to assess the likelihood that heart failure, pneumonia and/or Chronic Obstructive Pulmonary Disease (COPD) is the underlying diagnosis. During specific vignettes in the survey, participants will also be shown standard or systematically biased AI models that provide an estimate the likelihood that heart failure, pneumonia and/or COPD is the underlying diagnosis. Clinicians will be randomized see AI predictions alone or AI predictions with explanations when shown AI models. This survey design will allow for testing the hypothesis that systematically biased models would harm clinician diagnostic accuracy, but commonly used image-based explanations would help clinicians partially recover their performance.

Being tested
Artificial Intelligence model predictions without explanation, Artificial intelligence model predictions with explanation, AI model biased against heart failure, AI model biased against pneumonia, AI model biased against COPD
Keywords
Artificial Intelligence, Diagnostic Accuracy, Computer Assisted Diagnosis, Biased Model

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Artificial Intelligence model predictions without explanationOther

    During 6 clinical vignettes, participants will see AI model predictions without a corresponding AI explanation. The AI model will provide a score for each diagnosis (heart failure, pneumonia, COPD) on a scale of 0-100 estimating how likely the patient's presentation was due to each of these diagnoses. In 3 of the clinical vignettes, participants will be shown standard AI model predictions and 3 vignettes they will be shown systematically biased AI model predictions, with the model specifically biased against one of the three diagnoses.

  • Artificial intelligence model predictions with explanationOther

    During 6 clinical vignettes, participants will see AI model predictions with explanation. The AI model will provide a score for each diagnosis on a scale of 0-100. In 3 clinical vignettes, participants will be shown standard AI model predictions and 3 vignettes they will be shown systematically biased AI model predictions with the model specifically biased against one of the three diagnoses. If the AI model provides a score above 50 an AI model explanation will be shown as gradient-weighted class activation mapping (Grad-CAM) heatmaps overlaid on the chest X-ray that highlighted which regions of the image most affecting the AI model's prediction.

  • AI model biased against heart failureOther

    In 3 clinical vignettes, participants will be shown systematically biased AI model predictions with the model specifically biased against heart failure, always predicting that heart failure is present with high likelihood in survey vignette patients with a body mass index (BMI) at or above 30. Standard predictions will be shown for the other 2 diagnoses (pneumonia, COPD).

  • AI model biased against pneumoniaOther

    In 3 clinical vignettes, participants will be shown systematically biased AI model predictions with the model specifically biased against pneumonia, always predicting that pneumonia is present with high likelihood in survey vignette patients 80 years or older. Standard predictions will be shown for the other 2 diagnoses (heart failure, COPD).

  • AI model biased against COPDOther

    In 3 clinical vignettes, participants will be shown systematically biased AI model predictions with the model specifically biased against COPD, always predicting that COPD is present with high likelihood in survey vignette patients where a pre-processing filter was applied to the patient's X-ray. Standard predictions will be shown for the other 2 diagnoses (heart failure, pneumonia).

Study groups in NCT06098950
Study groupRoleWhat they receive
AI model biased for heart failure, no AI explanationExperimentalParticipants in this arm will be shown standard AI model predictions during 3 patient clinical vignettes within the survey and systematically biased AI model predictions during 3 clinical vignettes. When shown systematically biased AI model predictions, the model will be biased against heart failure, always predicting that heart failure is present with high likelihood in patients with a body mass index (BMI) at or above 30. Standard predictions will be shown for the other 2 diagnoses. Participants in this arm will not be shown an AI explanation when shown AI model predictions.
Receives: Other: Artificial Intelligence model predictions without explanation; Other: AI model biased against heart failure
AI model biased for pneumonia, no AI explanationExperimentalParticipants in this arm will be shown standard AI model predictions during 3 patient clinical vignettes within the survey and systematically biased AI model predictions during 3 clinical vignettes. When shown systematically biased AI model predictions, the model will be biased against pneumonia, always predicting that pneumonia is present with high likelihood in patients 80 years or older. Standard predictions will be shown for the other 2 diagnoses. Participants in this arm will not be shown an AI explanation when shown AI model predictions.
Receives: Other: Artificial Intelligence model predictions without explanation; Other: AI model biased against pneumonia
AI model biased for COPD, no AI explanationExperimentalParticipants in this arm will be shown standard AI model predictions during 3 patient clinical vignettes within the survey and systematically biased AI model predictions during 3 clinical vignettes. When shown systematically biased AI model predictions, the model will be biased against COPD, always predicting that COPD is present with high likelihood when a pre-processing filter was applied to the patient's X-ray. Standard predictions will be shown for the other 2 diagnoses. Participants in this arm will not be shown an AI explanation when shown AI model predictions.
Receives: Other: Artificial Intelligence model predictions without explanation; Other: AI model biased against COPD
AI model biased for heart failure, Image-based AI explanation presentedExperimentalParticipants in this arm will be shown standard AI model predictions during 3 patient clinical vignettes within the survey and systematically biased AI model predictions during 3 clinical vignettes. When shown systematically biased AI model predictions, the model will be biased against heart failure, always predicting that heart failure is present with high likelihood in patients with a body mass index (BMI) at or above 30. Standard predictions will be shown for the other 2 diagnoses. Participants in this arm will also be shown AI explanation when shown AI model predictions.
Receives: Other: Artificial intelligence model predictions with explanation; Other: AI model biased against heart failure
AI model biased for pneumonia, Image-based AI explanation presentedExperimentalParticipants in this arm will be shown standard AI model predictions during 3 patient clinical vignettes within the survey and systematically biased AI model predictions during 3 clinical vignettes. When shown systematically biased AI model predictions, the model will be biased against pneumonia, always predicting that pneumonia is present with high likelihood in patients 80 years or older. Standard predictions will be shown for the other 2 diagnoses. Participants in this arm will also be shown AI explanation when shown AI model predictions.
Receives: Other: Artificial intelligence model predictions with explanation; Other: AI model biased against pneumonia
AI model biased for COPD, Image-based AI explanation presentedExperimentalParticipants in this arm will be shown standard AI model predictions during 3 patient clinical vignettes within the survey and systematically biased AI model predictions during 3 clinical vignettes. When shown systematically biased AI model predictions, the model will be biased against COPD, always predicting that COPD is present with high likelihood when a pre-processing filter was applied to the patient's X-ray. Standard predictions will be shown for the other 2 diagnoses. Participants in this arm will also be shown AI explanation when shown AI model predictions.
Receives: Other: Artificial intelligence model predictions with explanation; Other: AI model biased against COPD

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Participant diagnostic accuracy across clinical vignette settings

    Diagnostic accuracy is defined as the number of correct diagnostic assessments over the total number of diagnostic assessments. After reviewing each individual patient clinical vignette within the survey, participants will be asked to make three separate diagnostic assessments for each clinical vignette, one for heart failure, pneumonia, and COPD. If the participant's assessment agrees with the reference label for each vignette, the diagnostic assessment is considered correct. Diagnostic assessments will be performed while participants are completing the survey (day 0), immediately after the participant reviews the clinical vignette. Participant diagnostic accuracy will be compared across vignette settings (no AI model, standard AI model, standard AI model with explanation, biased AI model, biased AI model with explanation).

    Measured: Day 0

Secondary outcomes (2)
  1. Treatment Selection Accuracy across clinical vignette settings

    Treatment selection accuracy is defined as whether the participant choose the correct treatment for the patient in the clinical vignette, and could choose any combination of steroids, antibiotics, Intravenous (IV) diuretics, or none of these treatments for the patient. Treatment selection assessments will be performed while participants are completing the survey (day 0), immediately after the participant reviews the clinical vignette. Participant treatment selection accuracy will be compared across vignette settings (no AI model, standard AI model, standard AI model with explanation, biased AI model, biased AI model with explanation).

    Measured: Day 0

  2. Diagnosis specific diagnostic accuracy across clinical vignette settings

    Diagnostic accuracy specific to heart failure, pneumonia, and COPD across vignette settings

    Measured: Day 0

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Oct 2023
  2. Study start1 Apr 2022
  3. Primary completion31 Jan 2023
  4. Study completion31 Jan 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
While participating in a survey, participants are randomized to see different hypothetical patient clinical vignettes, AI model predictions, and then ask questions about the patient's likely diagnosis and treatment.
Masking
Single blind
Who is masked
Participant
Enrolment
457 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06098950
Sponsor's protocol ID
HUM00180745
Other IDs
R01HL158626
Status last verified
Oct 2023
First submitted
17 Oct 2023
Last updated
25 Oct 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data could be made available to other researchers from accredited research institutions after entering into a data use agreement with the University of Michigan

Publications

  • Jabbour S, Fouhey D, Shepard S, Valley TS, Kazerooni EA, Banovic N, Wiens J, Sjoding MW. Measuring the Impact of AI in the Diagnosis of Hospitalized Patients: A Randomized Clinical Vignette Survey Study. JAMA. 2023 Dec 19;330(23):2275-2284. doi: 10.1001/jama.2023.22295.

    PubMed 38112814

Questions about this trial

What is this clinical trial studying?

A study testing Artificial Intelligence model predictions without explanation, Artificial intelligence model predictions with explanation and AI model biased against heart failure in people with Acute Respiratory Failure, run by University of Michigan at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Participant diagnostic accuracy across clinical vignette settings (time frame: Day 0). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06098950, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Oct 2023.

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