Pediatric Informatics: Computer Applications in Child Health (Health ...

180 M.J. Feldman
KB on infectious diseases makes it appropriate and useful to help diagnose
infections such as rabies. 28
For Isabel: Rabies was not listed in the differential diagnosis of 10–15 diseases,
but a related disease, viral meningoencephalitis was. In the “Using Synonyms”
mode, Isabel did not list rabies either with the 17 findings entered individually or
with the entire published textual description entered en block. 46
This case study illustrates the features of the MDDSS discussed in this chapter.
GIDEON’s prominent inclusion of the case diagnosis was perhaps predictable
given the system’s focus on infectious disease. While DXplain and Isabel did not
list rabies per se, they both listed a form of encephalitis, which might serve as a
diagnostic reminder of rabies, a specific type of encephalitis.
12.8 Pediatric Relevance of MDDSS
Historically, pediatric-specific MDDSS have been created specifically for use in
pediatric emergency medicine, 47 in rheumatology 48 and as part of general diagnostic
decision support systems. 4 The described Isabel system began its development
based on current pediatric textbooks.
Major pediatric textbooks are each over 2,500 pages in length, organized largely
by disease process, which require users to be familiar with the diagnoses contained
within them. There are also differential diagnosis handbooks in pediatrics 49 (and
other fields) that guide users through algorithms based on individual findings.
MDDSSs allow users to enter multiple clinical findings as a patient presents with
them and are based on essentially the same data as the textbooks, i.e. clinician
experience with patients summarized in the medical literature, but it is their ability
to organize, aggregate, weight, and display this information in a useful format that
can provide diagnostic support to the clinician, enhancing the care process.
12.9 Conclusion: Current Clinical Relevance of MDDSS
How are MDDSS useful in current clinical practice?
Expand a differential diagnosis
� MDDSS can provide differential diagnoses of a single clinical finding or of a
set of findings and can add unconsidered diagnoses
Educate clinicians about specific diagnoses
� MDDSS can provide links to disease-specific information from differential
diagnosis lists
Guide diagnosis in specialty domains
� MDDSS may be helpful in domains, such as GIDEON in infectious diseases
to guide further testing and therapy