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Computerized diagnostic referencing in pediatric emergency medicine
1Pediatric Emergency Service, Scottish Rite Children's Medical Center, Atlanta, Georgia.
Insights
Pediatric emergency diagnosis can be challenging for busy physicians. A computerized system (PEM-DXP) can quickly generate emergency differential diagnoses, potentially improving patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support Systems
- Medical Informatics
Background:
- Pediatricians face challenges in rapidly diagnosing complex cases, especially with limited access to up-to-date medical information.
- Physicians are often time-constrained and may not have immediate recall of all possible diagnoses for a given set of symptoms.
Observation:
- A case is presented of a 4-year-old child with fever and truncal rash who tragically died from a condition that might have been diagnosed earlier.
- Traditional diagnostic resources are cumbersome for emergency differential diagnosis in pediatric cases.
Findings:
- A computerized diagnostic support tool, PEM-DXP (Pediatric Emergency Medicine-Differential Diagnosis Program), can generate a list of critical diagnoses within 60 seconds.
- In the presented case, PEM-DXP could have provided a list including Rocky Mountain spotted fever, prompting further investigation.
Implications:
- Computerized diagnostic tools can aid physicians in considering a broader range of emergency diagnoses, especially in high-stress situations.
- Implementing such systems can help bridge the gap between the vast medical knowledge base and the practical limitations faced by clinicians, potentially improving patient safety and outcomes.
Abstract:
A well-qualified and dedicated pediatrician in a mid-Atlantic state recently cared for a 4-year-old child with a fever and a truncal rash. On the second visit the child was lethargic but seemed to improve with oral hydration and fever control. Twenty hours later the child's rash became petechial and the child returned moribund and died shortly thereafter. Looking for an emergency differential diagnosis on a 4-year-old child with fever and a truncal rash would have been cumbersome using traditional reference materials. With PEM-DXP, however, a nurse or secretary could have produced for the physician in 60 seconds a list of 12 emergency diagnoses to be considered. Rocky Mountain spotted fever would have appeared on that list. (Ten percent of patients with Rocky Mountain spotted fever have a maculopapular rash, and in 10% of those children the rash begins on the trunk.) This list might have prompted this physician to ask about a tick bite. A positive response would have been obtained. Possibly the tragic outcome, for both the child and the physician, could have been avoided. Children with urgent complaints are frequently cared for by physicians who are busy, tired, sleep-deprived, and stressed in many other ways. These physicians often have not read last month's medical journals in their specialty or even last year's journals. Yet the parents' expectation, and rightly so, is that their pediatrician or emergency physician has at his or her command and is bringing to bear on the care of their child the vast knowledge base of medical science as it pertains to their child's condition. It is a totally unrealistic expectation. By computerizing reference materials in ways that allow for selectively searching for and compiling information pertinent to a given presentation, however, we can move a bit closer to meeting both the parents' expectations of us and our own expectations of ourselves.