Evaluation of an Interactive Visualization Tool for the Interpretation of Pediatric Laboratory Test Results

The physiological age-related development of pediatric laboratory results interferes with pathological derangements, which can complicate the interpretation of test results. Recently proposed continuous reference intervals (RIs) promise to be beneficial, although their clinical use may depend on graphical presentations. To estimate the clinical utility of continuous RIs, we developed and evaluated an interactive visualization tool, and examined the differentiation of hemoglobinopathies that is attainable based on the underlying innovative RI model. The implemented web application allows users to easily enter laboratory test results, and displays various visualizations in conjunction with the corresponding RIs, such as charts and personalized Z-scores. To evaluate the usability of the visualization tool, we conducted concurrent think-aloud sessions with four physicians, who were prompted to solve a set of typical interpretation tasks, and acquired additional information through a questionnaire including the System Usability Scale (SUS). We used 85 de-identified clinical cases for an exemplified assessment of how well model-based interpretations of blood count parameters reproduced previously diagnosed hemoglobinopathies. Usability tests as well as questionnaire responses indicated that the developed tool was well received by the physicians. Results from the think-aloud evaluation revealed only minor problems and the tool reached an average SUS score of 86.9, suggesting good usability. Hemoglobinopathy discrimination depended on the considered subtype, although the overall performance of the novel method rivaled the one of the conventional approach. The interactive visualization of innovative continuous reference intervals demonstrated promising results, which justifies further testing on the path towards clinical routine.