AI-assisted Rare Disease Diagnosis
A Multicentre Randomised Controlled Trial of LLM-Assisted Diagnostic Support in Patients With Suspected Rare or Diagnostically Unresolved Disease
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Rare disease patients commonly experience prolonged diagnostic odysseys rooted in limited rare disease recognition, phenotypic heterogeneity, and dispersed diagnostic clues. Diagnostic decision-support large language models may improve first-visit consultations by integrating prior records, generating structured analyses, and proposing candidate diagnoses, thereby shortening diagnostic pathways and improving appropriate genetic testing referral.
Participating physicians will provide care under both AI-assisted and standard diagnostic workflows. Eligible patients will be individually randomised to receive either AI-assisted diagnostic support or standard clinical practice.
In the intervention arm, physicians will have diagnostic support from AI when seeing patients. In the control arm, patients are seen under standard hospital workflow without any generative AI tools. Outcomes adjudicated by an independent Expert Committee blinded to arm assignment; adjudicators access no AI-generated materials.
A prospective within-trial economic evaluation will be conducted alongside the randomized trial. Healthcare resource use and costs associated with the diagnostic pathway will be collected.
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Unzutreffend
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Shuyang Zhang, MD, PhD
- Telefonnummer: +86-13911667211
- E-Mail: shuyangzhang103@163.com
Studienorte
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Beijing, China
- Peking Union Medical College Hospital
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Kontakt:
- Shuyang Zhang
- Telefonnummer: +86-13911667211
- E-Mail: shuyangzhang103@163.com
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Cangzhou, China
- Cangzhou Central Hospital
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Kontakt:
- Yong Li
- Telefonnummer: +86-0317-2075013
- E-Mail: czszxyyirb@163.com
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Changchun, China
- Changchun Sacred Heart Hospital
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Dongguan, China
- Dongguan People's Hospital
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Foshan, China
- First People's Hospital of Foshan
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Guiyang, China
- Guizhou Provincial People's Hospital
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Jilin City, China
- Jilin Central General Hospital
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Kunming, China
- The First People's Hospital of Yunnan Province
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Tianjin, China
- Tianjin Children's Hospital
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Tianshui, China
- Tianshui 407 Hospital
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Kontakt:
- Rong Sun
- Telefonnummer: +86-0938-8229999
- E-Mail: ts407yy@sina.com
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Wuhai, China
- Wuhai People's Hospital
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Xining, China
- Qinghai Provincial People's Hospital
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Zhangzhou, China
- Zhangzhou Municipal Hospital of Fujian Province
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Kind
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Beschreibung
Patient Inclusion Criteria:
- Any age. Legal guardian co-signs consent for minors or individuals lacking legal capacity.
- Diagnostically unresolved or suspected rare disease, with at least one prior complete clinical evaluation at a secondary-level or higher institution yielding no confirmed explanatory diagnosis.
- First presentation to the enrolling institution for the current condition, with no prior records in the institutional HIS or outpatient system.
- No prior genetic testing related to the current condition; no results or reports available.
- Written informed consent provided voluntarily by patient or legal guardian, with commitment and ability to complete structured follow-up.
Patient Exclusion Criteria:
- Confirmed diagnosis (clinical, pathological, or molecular) explaining the primary symptoms.
- Emergency presentation, critical illness, or any condition incompatible with trial participation.
- Neither patient nor legally authorised proxy able to complete follow-up.
- Concurrent enrollment in another interventional study with diagnostic accuracy or genetic testing yield as a primary endpoint.
- Prior use of another AI system has already yielded a confirmed diagnosis for the current condition.
Physician Inclusion Criteria
- Licensed physician in internal medicine, neurology, pediatrics, general medicine, rare disease, or a related specialty.
- ≥2 years of clinical practice; competent to manage rare disease patients; stratified into junior or senior tier.
- Voluntary participation with written informed consent.
Physician Exclusion Criteria
- No longer in clinical practice, or unable to fulfill required outpatient duties during the study period.
- Unwilling to provide informed consent or to permit protocol-required collection of consultation and questionnaire data.
- Currently enrolled in another AI-assisted clinical workflow, or expected to be unable to comply with the procedures.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Diagnose
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Single
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
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Experimental: AI system
AI system will be used to provide diagnostic support during the encounter in addition to conventional clinical workflow.
Use of other generative AI tools is prohibited.
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The study AI system will be used to provide diagnostic support during the clinical encounter, including structuring relevant clinical information, generating a clinical analysis, and suggesting candidate diagnoses for review by the treating physician.
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Kein Eingriff: Standard of care
The physician conducts the encounter per standard hospital workflow using conventional clinical resources only.
Use of any generative AI tool is prohibited.
|
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Overall Correct Diagnostic Yield
Zeitfenster: From the first visit to final reference diagnosis adjudication, an average of 8 weeks.
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The proportion of all randomised patients whose clinical diagnosis by the end of follow-up is concordant with the blinded-adjudicated final reference diagnosis determined by an independent committee.
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From the first visit to final reference diagnosis adjudication, an average of 8 weeks.
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Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Physician-Reported Experience
Zeitfenster: Assessed at each consultation (day 1), within 1 day.
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Physicians will assess their experience of the diagnostic workflow.
Responses will be recorded using a standardized rating scale (range 1-5, where higher scores indicate more positive experience).
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Assessed at each consultation (day 1), within 1 day.
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Patient-Reported Experience
Zeitfenster: Assessed at each consultation (day 1), within 1 day.
|
Patients will assess their experience of the diagnostic workflow.
Responses will be recorded using a standardized rating scale (range 1-5, where higher scores indicate more positive experience).
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Assessed at each consultation (day 1), within 1 day.
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Appropriate Genetic Testing Recommendation Rate
Zeitfenster: From the initial consultation to genetic testing indication adjudication, approximately 8 weeks
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The proportion of randomized patients for whom physician-recommended genetic testing is concordant with the indication determined by an independent genetics adjudication committee.
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From the initial consultation to genetic testing indication adjudication, approximately 8 weeks
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Candidate Diagnostic Accuracy
Zeitfenster: From the first visit to final reference diagnosis adjudication, an average of 8 weeks.
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The agreement between physician-provided candidate diagnoses in the the initial consultation and the independently adjudicated reference diagnosis.
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From the first visit to final reference diagnosis adjudication, an average of 8 weeks.
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Molecular Diagnostic Yield
Zeitfenster: From the first visit to final reference diagnosis adjudication, an average of 8 weeks.
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The proportion of all randomized patients in whom genetic testing performed as part of the clinical diagnostic pathway identifies a clinically relevant molecular finding that is confirmed through independent genetics review.
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From the first visit to final reference diagnosis adjudication, an average of 8 weeks.
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Time to a Correct Diagnosis
Zeitfenster: From enrollment to the end of follow-up, up to 8 weeks.
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The number of days from the first study visit to the first physician-assigned diagnosis that is subsequently confirmed as concordant with the independently adjudicated reference diagnosis.
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From enrollment to the end of follow-up, up to 8 weeks.
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Duration of the Initial Physician Consultation
Zeitfenster: Assessed at each consultation (day 1), within 1 day.
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In-room consultation time will be recorded, measured, and compared between arms.
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Assessed at each consultation (day 1), within 1 day.
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Mitarbeiter
Mitarbeiter
Ermittler
Ermittler
- Hauptermittler: Shuyang Zhang, MD, PhD, Peking Union Medical College Hospital
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- PUMCH I-26PJ0002
Plan für individuelle Teilnehmerdaten (IPD)
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Beschreibung des IPD-Plans
IPD-Sharing-Zeitrahmen
IPD-Sharing-Zugriffskriterien
Art der unterstützenden IPD-Freigabeinformationen
- STUDIENPROTOKOLL
- SAFT
- ANALYTIC_CODE
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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