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

188 P.W. Dalrymple et al.
For pediatricians, a common visual information need is identification of normal
and abnormal skin findings and their linkage to disease states (“What is this
rash?”). Practitioners may capture and store visual data on skin samples using
digital cameras, which can be forwarded electronically to remote experts for teleconsultation.
Alternatively, online image repositories may be helpful for additional
discussions on unusual or interesting cases.
Dermatlas (www.dermatlas.org) is a free, collaborative, open access repository
(from Johns Hopkins University School of Medicine) of over 10,000 images
contributed by more than 400 physicians worldwide. Clinicians may enter clinical
observations in text format, and then retrieve skin images that correspond to
their observations, thus helping to confirm a diagnosis and pointing to additional
resources for treatment and prognosis. Dermatlas has a differential diagnosis feature
that links visual findings to aid the diagnostic process. It also links diagnoses to
medical literature references (via PubMed) and other information resources.
VisualDx (www.logicalimages.com/prodVDxProven.htm) is a subscriptionbased
online (or standalone) service (from Logical Images/Thomson Healthcare)
that provides clinical images and reference text to guide clinicians in making
diagnoses. Originally developed for dermatology, this tool is being extended to
other domains, including oral health. For skin lesions, users may use a specially
developed dermatology lexicon to enter lesion types, such as “lump or bump,”
“scabs” or “raised lesions” to augment a search based on historical findings
(exposures, previous diseases or travel).
A common auditory information need is the distinction of functional and pathologic
heart murmurs. Despite advanced technology for diagnosing structural heart
disease, auscultation is still the primary diagnostic examination, and auditory
identification of heart sounds and linkage to structural lesions is an important
pediatric skill. A library of heart sounds plays a similar role to the visual image
repositories.
CARD (www.murmurlab.com/card6) is an online library of digitized heart
sounds (from Johns Hopkins University School of Medicine) collected from
pediatric patients who have undergone echocardiography. To date, the database
contains over 5,000 individual recordings from over 900 patients, representing a
variety of normal and abnormal heart murmurs. The application allows adjustments
in heart rates and frequencies and graphic rendering of sounds, providing
an optimal learning and reference environment that can both educate and help
determine whether to refer for additional work-up. It is available free of charge. 9
13.3.2 Clinical Constellations
A diagnosis is often made not on the basis of a single finding (except for pathognomonic
associations), but on a co-occurrence of several findings in one patient.
Constellations of findings (history, examination, laboratory test results) associated