2021 Volume 61 Issue 1 Pages 17-23
Objective. Immune checkpoint inhibitors (ICIs) may cause immune system overactivation and subsequent immune-related adverse events (irAEs). The standard irAE manual aids in the diagnosis by starting from the disease name, followed by an examination and, finally, treatment. We developed a reverse manual for irAEs to facilitate suspicion of a disease based on the symptoms. Methods. We selected eight important irAE symptoms (fever, nausea, disturbed consciousness, fatigue, dyspnea, abdominal pain, headache, and limb weakness). When a patient presents with one of these suspected symptoms, additional questions can be asked, leading to a suspected disease name. Thereafter, we can use the standard irAE manual. We prepared eight virtual symptoms and the corresponding correct disease names and validated the effectiveness of our reverse manual for irAEs among four medical interns who were asked to answer the disease name with and without using the reverse manual for irAEs. Results. Without the reverse manual, the correct answer rate was low (0-25%), and the time to answer was long (6-12 min). In contrast, the use of the reverse manual resulted in a high correct answer rate (75-100%) and short time to answer (2-3 min). Conclusions. Our reverse manual for irAEs may be a useful tool for identifying a suspected disease name in a short time.