Patient online health searching is now commonplace, however, the accuracy of patient generated differentials for new symptoms and potential for patient anxiety are concerns. We aimed primarily to determine the accuracy of patient generated differentials for new symptoms with and without online searching, and secondarily, to evaluate the impact of searching on anxiety levels. In the waiting room prior to seeing a clinician, 300 patients with new symptoms were randomly assigned 1:1:1 to Google searching with health related features including a symptom search tool vs Google searching with health related features disabled vs no searching. Participants were 18 years or older and presenting to the emergency department of an urban academic medical center with new low-acuity symptoms that were not due to exacerbation of a chronic condition. Search groups received access on a tablet/smartphone to Google searching with or without health related features. Both search groups could access any websites; health related features led the patient to common diagnoses and physician-validated information. The primary outcome was accuracy of the patient generated differential assessed by matching at least two of the top three diagnoses on the clinician’s differential. A secondary outcome was anxiety by a visual analogue scale. Patients were a median of 33.1 (IQI 26.2–45.9) years old, 60% women, 63% black, 82% had a high school education or less, and 45.7% reported having performed an online search prior to presentation. Search group patients spent a median of 3.82 (2.53–5.72) minutes searching online. Similar proportions of patients in each group matched at least two of three clinician diagnoses: 27.0% and 28.3% for Google searching with and without health related features vs 23.8% in the no search group. Patients in the search groups had a similar odds of matching ≥2/3 diagnoses as the no search group [OR (95% CI): 1.23 (0.70–2.13), p = 0.47]. Anxiety was unchanged with online searching. In conclusion, brief online searching in the waiting room did not improve accuracy of patient generated differential diagnoses for new symptoms. The absence of an increase in patient anxiety provides reassurance for subsequent work to refine and investigate online symptom search tools.

病人在线健康搜​​索现在很普遍，但是，病人产生的新症状差异的准确性和病人焦虑的可能性值得关注。我们的主要目的是通过在线搜索和不在线搜索来确定患者产生的新症状差异的准确性，其次，以评估搜索对焦虑水平的影响。在会见临床医生之前的候诊室中，将300例具有新症状的患者随​​机分配给具有健康相关功能的Google搜索，包括症状搜索工具与禁用了健康相关功能的Google搜索vs不进行搜索。参与者年满18岁，并向城市学术医疗中心的急诊科就诊，出现了新的低眼压症状，这些症状不是由于慢性病加重引起的。搜索组可以在平板电脑/智能手机上使用Google搜索功能，无论是否具有与健康相关的功能。这两个搜索组都可以访问任何网站；与健康相关的特征使患者获得了常见的诊断和经医生验证的信息。主要结果是通过匹配临床医生的差异诊断中前三项诊断中的至少两项来评估患者产生的差异的准确性。次要结果是通过视觉模拟量表进行的焦虑评估。患者的中位年龄为33.1（IQI 26.2-45.9）岁，女性为60％，黑人为63％，高中或以下文化程度为82％，据报道有45.7％的患者在就诊前进行了在线搜索。搜索组患者在在线搜索上花费的中位数为3.82（2.53–5.72）分钟。每组中相似比例的患者至少符合以下三种临床诊断中的两种：具有和不具有与健康相关的功能的Google搜索分别为27.0％和28.3％，而无搜索组为23.8％。搜寻组中的患者匹配诊断≥2/ 3的几率与不搜寻组相似[OR（95％CI）：1.23（0.70–2.13），p  ＝ 0.47]。在线搜索的焦虑没有改变。总之，在候诊室进行简短的在线搜索并不能提高患者对新症状进行鉴别诊断的准确性。病人焦虑的增加不会为后续工作提供保证，以完善和研究在线症状搜索工具。