The correct diagnosis was

proposed at the first rank by the travel physicians in 70% of the cases, and by KABISA TRAVEL in 72% (p = 0.56), and was cited in the top five ranking of both “competitors” in 88% of the cases (p = 0.85). No significant difference between the performances of travel physicians and of KABISA TRAVEL was observed for any specific diagnosis. Of note, tropical conditions were more frequently correctly diagnosed Pembrolizumab supplier both by travel physicians and by KABISA TRAVEL than the cosmopolitan diseases as first diagnosis (78% vs 56%, p = 0.001 and 83% vs 53%, p < 0.001, respectively) and within the top five ranking (92% vs 82%, p = 0.03, for both comparisons). These differences disappeared when the malaria cases were removed from analysis, except for KABISA TRAVEL for the first diagnosis (75% vs 53%, p = 0.013). Eleven diagnoses were not included in the five first proposals of travel physicians neither in those of KABISA see more TRAVEL; 13 were included by KABISA TRAVEL but not by travel physicians, and 14 were included by travel physicians but not by KABISA TRAVEL. Reasons for missed diagnoses by KABISA (14) were absence of findings (2) or diseases

(1) in the database, not updated incidence (3), wrong computation (2), and atypical clinical presentation (9). When both clinicians and KABISA did not include the correct diagnosis in the first five (11), for KABISA atypical

presentation was the only and constant cause. For missed diagnoses by clinicians alone no data are available in this study. Details on missed diagnoses are provided in Table 3. Finally, when analyzing the subset of 36 patients with final nonconfirmed diagnoses, it is interesting to note that the initial diagnoses proposed by travel physicians and by KABISA TRAVEL were rather similar and often close to this final clinical suspicion (Table 4). The answers to the survey about the clinical utility of KABISA TRAVEL are reported in Table 5. Data were available for 198 patients. Travel physicians reported that they had been influenced by KABISA TRAVEL for the choice of further pheromone investigations in 16% of the cases, but much more frequently when they did not initially find the correct diagnosis (48% vs 12%, p < 0.001). They reported to have been helped for finding the correct diagnosis in 24% of the cases, and also more often when the correct diagnosis had not been mentioned in the initial list (48% vs 21%; p = 0.005). A median of 10 findings was spontaneously entered by the coinvestigators for all cases under study. After the travel physicians had entered all data they found relevant, KABISA TRAVEL still requested additional information in 81.5% of the cases. A median of three additional findings was asked by the system before considering the cases as fully explored.