Challenges in evaluating the accuracy of AI-containing digital triage systems: A systematic review

INTRODUCTION: Patient-operated digital triage systems with AI components are becoming increasingly common. However, previous reviews have found a limited amount of research on such systems’ accuracy. This systematic review of the literature aimed to identify the main challenges in determining the accuracy of patient-operated digital AI-based triage systems. METHODS: A systematic review was designed and conducted in accordance with PRISMA guidelines in October 2021 using PubMed, Scopus and Web of Science. Articles were included if they assessed the accuracy of a patient-operated digital triage system that had an AI-component and could triage a general primary care population. Limitations and other pertinent data were extracted, synthesized and analysed. Risk of bias was not analysed as this review studied the included articles’ limitations (rather than results). Results were synthesized qualitatively using a thematic analysis. RESULTS: The search generated 76 articles and following exclusion 8 articles (6 primary articles and 2 reviews) were included in the analysis. Articles’ limitations were synthesized into three groups: epistemological, ontological and methodological limitations. Limitations varied with regards to intractability and the level to which they can be addressed through methodological choices. Certain methodological limitations related to testing triage systems using vignettes can be addressed through methodological adjustments, whereas epistemological and ontological limitations require that readers of such studies appraise the studies with limitations in mind. DISCUSSION: The reviewed literature highlights recurring limitations and challenges in studying the accuracy of patient-operated digital triage systems with AI components. Some of these challenges can be addressed through methodology whereas others are intrinsic to the area of inquiry and involve unavoidable trade-offs. Future studies should take these limitations in consideration in order to better address the current knowledge gaps in the literature.