Updating Beliefs using New Evidence from a Diagnostic Decision-Support Aid in a Nurse-Led First-Seizure Clinic

Recent studies using computational and mathematical interrogation of background EEG have revealed eight biomarkers that inform a diagnostic decision-support tool called BioEP. To assess the utility of BioEP for aiding clinical decision making, we conducted a prospective single-site diagnostic belief updating study (NCT05764252). Eighty-six adults with suspected seizures attended a nurse-led, first-seizure clinic. Using a 7-point scale ranging from virtually certain to exceptionally unlikely, two clinicians independently rated the probability of having another epileptic seizure before and after reviewing BioEP scores. Recruitment took place over 1 year. The probability ratings changed (beliefs updated) by at least one category in 35/86 participants for Reviewer 1 (41%; 95% confidence interval: 30-51%) and in 58/86 people for Reviewer 2 (67%; 58 to 77%). The impact of the presentation of new evidence from the BioEP score on reviewer beliefs was substantial and bidirectional. For Reviewer 1 n=20 lower and n=15 higher probability, with n=37 lower and n=21 higher probability for Reviewer 2. Future research will explore the impact of these biomarkers on long-term diagnostic decision making and examine robustness and generalisability in multi-site settings.