With the ubiquitous availability of smart phones, point-of-care technology becomes increasingly sophisticated. Many are familiar with mobile drug information resources (eg. Lexicomp, Epocrates), but now information is increasingly disease-specific. An example of this and the data supporting this are available in a recent publication with regards to diagnosing Kawasaki disease(KD) (J Pediatr 2013; 162: 183-88).
After simulating a model with a training cohort of 276 patients with KD and 243 febrile control (FC) patients, the authors validated the model with 136 patients with KD and 121 FCs. Inclusion criteria for KD were based on the American Heart Association guidelines.
The scoring system which combined clinical findings and laboratory findings resulted in “a sensitive (>95% PPV) and specific (>95% NPV) diagnosis of ~60% of FCs and ~75% of patients with KD.” In essence, the patients with high or low scores for KD were quite reliable.
To check out the web site:
http://translationalmedicine.stanford.edu/cgi-bin/KD/kd.pl
Potential limitation: The personnel involved in the study were very experienced in KD; thus, the model may be less effective when less skilled personnel obtain the clinical information.
While pediatric gastroenterologists do not frequently see KD patients, the bigger issue is developing point-of care tools. In our electronic health record (EHR), one point-of-care tool I developed was a smart phrase to assess hospitalized patient’s with colitis (see bottom of post in blue). This smart phrase can be pulled up with three key strokes and helps me assess the severity of the patient’s colitis.
Another useful smartphrase in blue (that was shared with me from Mike Hart), also retrieved with three key strokes, is the following:
Here is a weblink on youtube for a video on changing Mic-Key buttons:
http://www.youtube.com/watch?v=Mn4ePSBiCTk
I often share this link with parents at the end of my “after visit summary” note.
These types of tools can improve recognition and treatment in a wide range of areas and are only limited by our imagination.
Pediatric UC Activity Index:
1. Abd pain
No pain —0 points, Pain can be ignored —5 points, Pain cannot be ignored—10 points
2. Rectal bleeding
None —0 points, Small amount & in <50% of stools — 10 points, small with most stools —20 Large amount —30 points
3. Stool consistency
Formed — 0 points, partially formed — 5 points, completely unformed —10 points.
4. #Stools/24hrs
0-2 —0 points, 3-5 —5 points, 6-8 — 10 points, > 8 15 points
5. Nocturnal Stools
No —0 points, Yes —10 points
6. Activity Level
No limitation —0 points, Occasional limitation —5 points, Severe limitations —10 points
Total Score: *** @TD@
Interpretation:
Remission <10, Mild dz 10-30, Mod dz 31-64, Severe dz >65
References:
1. Gastroenterology 2010; 138: 2282-2291. PUCAI helps predict IV steroid failure in hospitalized pediatric colitis pts. n=128. 37 failed IV steroids (29%)
Score >45 (on day 3) indicates pts likely to fail IV steroids: Pos PPV 43%, Neg PPV 94%
Score >70 (on day 5) indicates need for alternate rx (+PPV100%)
25/33 steroid failures responded to IFX. Colectomy rate 9% initial, & 19% at 1 year.
2. Gastroeterology 2007; 133: 423-32. Turner et al.
Related blog entry:
gutsandgrowth 