WO1996019774A1 - Systeme interactif a interface graphique pour l'assistance au personnel medical en vue du diagnostic, du traitement et du suivi de patients operes ou souffrant d'un traumatisme - Google Patents

Systeme interactif a interface graphique pour l'assistance au personnel medical en vue du diagnostic, du traitement et du suivi de patients operes ou souffrant d'un traumatisme Download PDF

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Publication number
WO1996019774A1
WO1996019774A1 PCT/US1995/016611 US9516611W WO9619774A1 WO 1996019774 A1 WO1996019774 A1 WO 1996019774A1 US 9516611 W US9516611 W US 9516611W WO 9619774 A1 WO9619774 A1 WO 9619774A1
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WIPO (PCT)
Prior art keywords
information
data
patient
graphical
injury
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PCT/US1995/016611
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English (en)
Inventor
John H. Siegel
Philip Marsh
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University Of Medicine And Dentistry Of New Jersey
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Application filed by University Of Medicine And Dentistry Of New Jersey filed Critical University Of Medicine And Dentistry Of New Jersey
Priority to AU45255/96A priority Critical patent/AU4525596A/en
Publication of WO1996019774A1 publication Critical patent/WO1996019774A1/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/60—ICT specially adapted for the handling or processing of medical references relating to pathologies
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H30/00—ICT specially adapted for the handling or processing of medical images
    • G16H30/40—ICT specially adapted for the handling or processing of medical images for processing medical images, e.g. editing

Definitions

  • This invention relates generally to systems for assisting medical professionals or para-professionals in the diagnosis, treatment and management of surgical and trauma patients, and the recordation and analysis of data related thereto, and more particularly to such a system embodying an interaction between the medical professional or para-professional and a stored electronic database via a computer driven graphical interface.
  • a computer based interactive graphic methodology and a system for carrying out that methodology, permit delineation and recording of physiologic, demographic and other relevant data for a diseased or injured patient.
  • An interface with physiological monitoring systems and with radiological image data bases is supported by the invention, as is a graphical presentation of patterns of multivariable physiological data which describe, classify and quantify the adequacy of a patient's host defense response to injury (12).
  • the system of the invention is particularly applicable to trauma patients where injuries may be delineated and recorded with regard to their cause, severity and location both on the body surface and within the organs.
  • the system can also record the consequences of blunt and penetrating traumas on the various organs and functions of the body.
  • the system further converts information about mechanisms of trauma and the patient diagnostic examination graphics, as entered by the physician using the graphical interface of the invention, into definitive textual statements, AIS 90 and diagnostic codings (ICD.9), and also permits the designations of therapeutic resuscitation and operative procedures, with their CPT codes. These data then can be used to fulfill medical record keeping, quality assurance and improvement, and third party carrier reimbursement requirements. Also, the delineation of details of admission physical exam abnormalities permits the identification of specific resuscitative and emergency surgical maneuvers that may be required.
  • admission physiologic and biochemical data are recorded and stored, thereby providing a time sequential clinical record in which updates of changes in the patient's condition and more in-depth system physical examinations by consulting specialists can be noted.
  • an automated record is constructed which has both simple anatomically relevant explanatory graphics as well as alpha-numeric and textual presentation capabilities. This also provides for a review of a patient's course either by examination of serial anatomic and physiologically based graphic representations of the patient's abnormalities or by generation of a textual record.
  • the system allows the formatting of therapeutic advisories (Rx) which can be used to convey state-of-the art protocols and caveats relative to the specific conditions manifested by the patient.
  • Rx therapeutic advisories
  • These advisories also provide rapid error free computation of drug dosage and protocols of administration for generally accepted urgent therapeutic agents (e.g. , initial fluid replacement therapy for burn victims or body weight dependent initial steroid doses in patients with spinal cord injury).
  • the data created by the entry of graphic and category information produced by cursor or alphameric input can be transferred to a conventional data base supported by the standard statistical analysis program (IS AS SPSS, or SPLUS). These statistical programs can be assessed from the COZY interface at the bottom of each screen display.
  • FIG. 1 shows a depiction of the graphical image for an initial examination screen according to the invention. That screen is specifically directed to body surface image and additionally includes identification demographics, E code, and third party carrier information.
  • FIG. 2 shows a screen image for localization of injuries to skull and facial bones and Glasgow Coma Scale (GCS) parameters to compute level of physiologic brain dysfunction (GCS score).
  • FIG. 3 shows a screen image for localization of motor, sensory and proprioception abnormalities and their completeness produced by blunt or penetrating injuries of the spinal cord.
  • GCS Glasgow Coma Scale
  • FIG. 4 shows a progression of the injury shown in FIG. 3.
  • FIG. 5 shows a screen image for localization of skeletal fracture injuries and for sprains, ligament disruptions and dislocations of joints.
  • FIG. 6 shows a screen image for localization of injuries to thoracic and abdominal cavity viscera with delineation of injury severity.
  • FIG. 7 shows a screen image of the retroperitoneal organs and their major vascular supply and drainage.
  • FIG. 8 shows a screen image of anatomy of hepatic vascular segments, major portal and hepatic venous anatomy, extra hepatic biliary and pancreatic ductal anatomy.
  • FIG. 9 shows a screen image of anatomic scheme of the major arterial system, including the intracranial vessels, with each major segment or division designated.
  • FIG. 10 shows exemplary therapeutic procedures for trauma resuscitation with their CPT codes.
  • FIG. 11 shows a screen diagram of a motor vehicle passenger compartment, for localization of points of contact or contact intrusion which acted as causative agents for injuries previously designated by interaction with anatomic screen diagrams.
  • FIG. 12 (A, B & C) show exemplary therapeutic advisories for burn trauma patients.
  • FIG. 13 (A & B) show the screen images for patient reporting, following examination.
  • FIG. 13A depicts the screen before entries are made, while FIG. 13B depicts the screen after such entries.
  • FIG. 14 (A, B, C & D) comprise a printout of an operative notes accessed via the patient report screen of FIG. 13, derived from information concatanted by the program from the anatomic injury location data, the severity code designation (which produces the ICD.9 coding) and the therapeutic procedure windows (which allows the relationship of the ICD.9 code for each specific injury to be linked to a CPT therapeutic code).
  • This output also delineates the AIS (Abbreviated Injury Score) for each injury, the nature of the surgical procedure, the type of incision, and the occurrence of specialized aspects of the surgical operation (e.g.
  • an alphameric text entry capability is available so that details of the procedure and unexpected complications or impressions can be delineated by the operation surgeon.
  • a computer based, interactive graphic methodology for assisting a medical professional or para-professional in the management of abnormal physiological conditions, particularly with respect to the establishment and maintenance of record data regarding patient physiologic and demographic data and the establishment of relational linkage between such data and diagnostic and treatment protocols relevant to conditions defined by such data.
  • the discussion herein will be focused on the application of that methodology to trauma cases, which will constitute a preferred embodiment of the invention. It will be readily apparent,however, to those skilled in the medical and surgical arts that the invention will be of great value in diagnosis, treatment and management for medicine and surgery patients, and the recordation of data related thereto.
  • the interactive graphic methodology of the invention will permit an examining surgeon, surgical resident, physician's assistant or specialty surgical consultants to delineate and record traumatic injuries with regard to their cause ⁇ keyed to a classification standard such as ICD.9 E codes (13), location on the body surface and internal body organs and structures, and with regard to their severity grade — using a system compatible with the causation coding.
  • the system also facilitates the recording of admission physiologic and biochemical data.
  • the interactive graphic modules of the invention also permit the recording of a full neurological examination and the delineation of the location, nature and complexity of skeletal system fractures which are the result of a traumatic insult.
  • the system allows for the recording of acute surgical resuscitative therapies and initial and subsequent operative procedures with their CPT codes (14), and provides for a complete record of all injuries and admitting diagnosis with their ICD.9 codes.
  • the medical graphics user interface application is based on the utilization of a library of real time transaction processing objects.
  • these objects are written utilizing the American National Standard for Information Systems - Programming language C, ANS X3.159-1989, as well as The National Institute of Standards and Technology (formerly the National Bureau of Standards) Portable Operating System Interface for Computer Environments (POSIX) in order to comport with the Federal Information Processing Standard. All graphics are performed with XI 1 from the X consortium and the Open Software Foundation's Motif tool kit, operating with Release 5. The use of these standards has produced highly portable client/ server objects. These objects fall into configurable classes which are reused across the suite of programs.
  • the major classes of objects include:
  • the drawing class produces a vector map of an anatomically correct drawing.
  • the user can, by using an interface device such as a "mouse”, point and click on an anatomical feature to indicate a point of injury.
  • the injury will be displayed as an injury symbol, where each injury has a unique symbol code, or as a generalized area of injury designated by a change in the background color of the anatomical feature.
  • the drawing class has a full feature editor, permitting the user to remove erroneous entries.
  • This class is fully integrated with the database class which permits the user to analyze historical entries, do time-line analysis and to enter new injury information as an amendment to a prior examination. For numerous applications a list of anatomical names are displayed. When the user points at an anatomical feature, the name of the feature is highlighted.
  • the command class allows the user to select the current active injury code — both ICD.9 and AIS 90 (8) coding are supported in the preferred embodiment. These codes may be associated with shaded 3-dimensional push buttons depicted on the screen which are selected with the mouse. The active injury code will be prominently displayed as is the legend of injury codes.
  • the advisory class provides the user with any useful medical information that may be available for the particular trauma condition.
  • This function will automatically compute fluid therapy and dosages of medications based on height, weight and body surface area.
  • This function also analyzes the examination to determine if therapeutic advisories are required for any special conditions (e.g. , circumferential or facial burns or spinal cord injuries).
  • the database class permits the user to store, amend and retrieve patient information on an advanced network server.
  • This server system properly configured to one or more internal and/or external computer networks — e.g. , the Internet, makes all patient information available throughout the treating institution, or world wide in the case of a system of such institutions.
  • the user may list all patients in the database or selectively search for a patient name or ID number.
  • the user will receive a list of patient examination dates and times which can be called up.
  • the user may then file a completely new examination, or may file modifications to specific aspects of an old examination by editing, in or out, the change in the patient's condition. This creates a time sequential record of patient condition changes.
  • This class will also permit the deletion or modification of an incorrectly entered old exam, but is password protected to protect against unauthorized changes.
  • the terminal I/O class is a non-interrogatory data entry system that permits the user to enter textual information about the patient including identification, insurance, admissions and physiologic data. It may be embodied as a form on the screen, where the user points to the blank to be filled in and enters the appropriate text from a keyboard.
  • the choice class produces a check list of conditions that may be found during an examination where the using physician points to and clicks on the appropriate box.
  • Illustrative examples for this class are: a. Chest exam + x-ray b. Abdominal exam + x-ray c. Glasgow Coma Scale Scoring d. Central Nervous System and spinal cord neurologic function tests e. indicators of sinus fractures and CNS fluid leaks, classifications of types facial fractures by LeFort class f . Central Nervous System Brain hematomas g. Joint sprains, ligament disruptions, and dislocations h. Motor vehicle crash injury contact points i. Severity of injury grades (I- VI) j. Operative procedures with their CPT codes k. Interfaces with physiological monitoring systems
  • This Diagnostic Examination system is comprised essentially of a group of interrelated programs which enable and guide the recording of the physical examination and radiologic diagnosis of injured or burned trauma patients. It is established to be utilized by paramedical or medical trained personnel who might have a relatively limited experience in the evaluation of the seriously injured patient. Therefore, it is based on the utilization of a consistent diagnostic graphic format based on a series of body images which can be addressed by the examiner in a systematic fashion. These allow the recording of abnormalities noted on direct physical examination, or on the basis of information that might be obtained by specialized diagnostic equipment providing radiologic or ultrasound imaging. The format also permits the introduction of biochemical and physiologic information that might be obtained from standard biochemical analytic devices or physiologic sensors.
  • These data can be entered either electronically as digitized data obtained from a laboratory medicine analysis system — using a networked connection to such a system, directly from a patient physiologic monitoring system via a hard-wired connection, such as an RS-232 interface, or by manual keyboard entry of appropriate numbers which quantify the parameters of physiologic function, such as blood pressure or heart rate.
  • the system additionally permits time indexed serial recordings of all systems, so that the admission physical examination, physiologic data and laboratory information can then serve as baselines for the interpretation of later changes seen in subsequent examinations.
  • FIG. 1 The initial diagnostic format, body surface image (Skin/Body), is shown in FIG. 1.
  • This image contains identification demographics, ICD.9 E code, and third party carrier information.
  • this screen is also characterized by a number of graphically depicted "hot buttons" for localization of causative agents, physiologic data entry correlations to physical examination (PE) abnormalities and indicator buttons for findings that may be syntheses of PE and radiologic examinations, as well as a listing of Workspace Names at the bottom of image which allow selection of other anatomic images relevant to the abnormalities noted on PE, or after surgical exploration, CT, or angiographic studies.
  • PE physical examination
  • the graphical image includes other "hot buttons” for therapeutic advisories [Rx] and Surgical and Resuscitative procedures [Sx], which will be described hereafter.
  • These "hot buttons” and Workspace Names can be accessed by the use of an interface device such as a mouse controller or trac ball driven cursor.
  • This first image demonstrates an anatomic diagram of the front and back of the body surface delineated into identifiable regions for localization of injuries or other abnormalities. It is important to note that all of the various diagnostic formats can be called to the screen by placing the mouse driven pointer on one of the specific Workspace Names at the bottom of the screen. These allow for the selection of images relevant to injuries to the body surface area (Skin/Body), head, face and brain (Skull/CNS), neurologic injuries which involve the spinal cord (Spinal Cord); or skeletal injuries (Skeleton). Images of the thoraco-abdominal viscera (Viscera), of the retroperitoneal organs (Retroperit) and of the peripheral arterial circulatory system (Vase) can also be selected to record injuries.
  • Vicera thoraco-abdominal viscera
  • Retroperit retroperitoneal organs
  • Vase peripheral arterial circulatory system
  • the examiner will begin the recording of the diagnostic session with the body surface image (Skin/Body) associated clinical observations and physiologic data obtained on first examination after the trauma (FIG. 1).
  • This body surface image is used to enter the findings of the initial physical examination and is of considerable importance in localizing the causative agents of all the traumatic injuries considered.
  • the MOTIF WINDOW format for the delineation of the nature and location of traumatic injuries is designed to produce a computer based clinical record file which can replace other types of paper records. More important, all of these images can be directly communicated by a computer located on a network maintained by the treating institution to a similar computer in the institution's Record Room to establish a permanent record. Such image data can also be sent to another remote location, so that consultation with a more experienced Trauma Surgeon or consultant can be requested with sufficient details to allow the general nature and urgency of the request to be conveyed before the actual patient contact is established. That consultation examination can also be recorded.
  • the patient's demographic information which may be entered via the keyboard, or could be initiated by a magnetic card reader or other appropriate input device.
  • These data include the patient's name, age, body weight, sex, and ethnic origin as well as an identifying unit number, social security number, a trauma or special study number, as well as patient address and any insurance information as required.
  • This information can be modified appropriately to fit any specific record keeping system and could be automatically entered from an insurance plan or federal magnetic card for those patients whose identity is known at the time of admission.
  • the date of examination is automatically entered based on the time of the initial entry of patient examination information.
  • the examination time can be changed by the individual conducting the initial examination to reflect some earlier time period than the actual computer entry, where there has been a significant delay between the physical examination and the time of data entry.
  • the sequencing of examinations with regard to time permits serial physical evaluations, using the image of each body system, to be made with their exact times recorded.
  • BARO TR Extra Vehicular Activity
  • the physiological and relevant biochemical information obtained when an injured patient is placed on the physiologic monitoring system permit the hemodynamic, respiratory and metabolic consequences of the injury to be related to the physical injury examinations. In this way, changes in patient status can be assessed and the rate of alteration in physical injury severity can be coordinated with physiologic studies obtained by invasive or non-invasive sensor systems. These data allow categorization of the nature of the trauma and stratification of the trauma episode with regard to its severity. The acquisition and recording of these data are critical to trauma severity staging, since most of the various scaling systems for injury severity utilize one or more of such physiologic and biochemical parameters, as well as the specific anatomic information regarding the injury and its severity.
  • FIG. 1 Skin and Body Surface
  • FIG. 2 Skull and Central Nervous System
  • FIG. 3 Spinal Cord
  • FIG. 4 Skeleton
  • CT computed tomographic
  • the physical examination data indicated in each of the various body images presented in this system are entered by the use of the mouse pointer (or other cursor manipulator) and qualified by user interaction with the various soft keys or "hot buttons" provided on the graphic surface.
  • On the left side of the image shown in FIG. 1 are a variety of these "hot buttons", which will be depicted in different colors. These permit the examiner to qualify the nature and the degree of injury with respect to the region of the body surface specifically designated using the mouse.
  • a touch sensitive screen with a pointer can be implemented to function in exactly the same way .
  • the system is designed to allow the "hot button” description to specify the injury to an area using the focal injury pointer (cursor) to locate the site of injury. For example in FIG.
  • the location and degree of a body surface bum are indicated by placing the cursor over the specific body area after first activating the "hot button" for that degree of bum (1°,2°, or 3°).
  • each designated region of the body is named with regards to its anatomic location so that a precise textual designation can also be developed for a written report.
  • the program automatically sums the second and third degree bum areas, both individually by degree and collectively, so as to automatically compute a total percent of body surface bum. This, as noted later in the discussion related to Therapeutic Advisory (Rx), allows for the computation of an initial fluid replacement therapy for the bum patient.
  • the examiner can localize the point of contact injuries, such as contusions, or penetrating injuries caused by gunshot, shotgun or stab wounds and can plot the course of superficial or deep lacerations or blunt traumatic contusions across the body surface.
  • These local points of blunt or penetrating trauma can be designated by using the focal cursor after activating the "hot button" for gunshot wound, stab wound, blunt trauma, deep laceration, etc. This will cause a specific symbol to be placed over the point of entry or serial symbols along the course of a laceration or contusion.
  • exit wounds can be indicated by the specific injury symbol, modified by a double image (which may be created by using a different mouse button) over the point of exit of the penetration.
  • This allows a precise designation of the body surface injury and/or its trans-corporeal course to be related to deeper injuries of body organs or skeletal structures, as shown in subsequent diagrams.
  • surface blunt contusions can be designated and their localization on the body surface can be shown by activating the blunt contusions "hot button". More than one injury can be delineated for a given body surface region. This is also shown in FIG. 1 where both a blunt contusion and bum have occurred in the same area, as with an explosion injury followed by fire.
  • the surface injury in this example a stab wound
  • the specific mass "hot button” activating the specific mass "hot button” and the mass size and physical characteristics such as expansion or pulseatility can also be indicated.
  • the importance of the specific "diagnostic indicators" of FIG. 1 is not only that they serve to record data, but also that they alert the examining individual to critical examination questions that need to be answered by all means available (observation, physical exam, x-ray diagnosis, etc.).
  • the examiner is requested to provide information about chest wall stability, or the presence of a sucking chest wound, a shift of the trachea, the presence of a physical diagnostically or radiologically demonstrable pneumo or hemothorax and the location of lung parenchymal lesions.
  • the characteristics of the heart sounds and the presence of any radiologic mediastinal widening are requested during the cardiovascular examination.
  • the abdominal physical examination is completed by recording the finding of specific signs and symptoms including information about the bowel sounds, the level of distension and the location of tenderness, rigidity or rebound. Radiologic or ultrasound identified presence of bowel air/fluid levels, or free intra abdominal air or fluid can be indicated. The presence and characteristics of any emesis can be designated and the results of a rectal examination including the presence of tenderness, or of overt or occult blood can be indicated. These specific pieces of information are critical to a complete physical examination in interpreting the severity of various types of injuries and if present, they must be delineated by the individual who has done the examination.
  • the second image screen allows for the localization and recording of physical and physiological information related to injuries of the head, face and brain (Skull/CNS).
  • This image right and left sided skull diagrams are presented so that face and skull fractures can be designated, together with a set of questions regarding the level of over all Central Nervous System (CNS) neurologic function.
  • CCS Central Nervous System
  • These observations represent the information required to develop and compute the Glasgow Coma Scale (GCS) Score.
  • GCS Glasgow Coma Scale
  • Information such as whether an emergency intubation (T) has been carried out for airway control can also be entered to modify the Glasgow Coma Scale Score computation (e.g.
  • the system allows all information to be integrated and presented for diagnostic decision making. Not only can the type and severity of fractures to the bones of the skull or face be indicated, (simple, comminuted, or compound and their combinations), but also for brain injury it allows the neurologic examination to be linked with information that can be obtained from diagnostic imaging (CT or MRI). Indicators for the presence and location of intracerebral bleeding or epidural or subdural hematomas allows these complications to be recorded, as well as any resultant shift of midline structures. The graphic integration of all of these data provides information of great diagnostic significance in determining the level of therapeutic response that may need to be initiated in a head injured patient.
  • the second neurologic examination image (Spinal Cord), as depicted in FIG. 3, is related to the evaluation of individuals with suspected spinal cord injuries.
  • the examining physician and/or the neurosurgical consultant can indicate the nature of the initiating injury, and its location if that is known, such as one that might be associated with an extemal wound produced by a sharp object or missile, or due to blunt trauma causing a spinal column fracture.
  • Placing the mouse cursor on the body image localizes the specific level and the side of the body at which a neurologic disfunction occurs.
  • the presence of complete or partial motor, sensory and proprioceptive function is designated by touching the "hot button" and localizing the cursor at the spinal cord level on the body image.
  • this information can be recorded for visual presentation so that it can be compared with later examinations that might be made on the same individual over the post injury time period during which therapeutic modalities are being administered. In this way the presence of an incomplete lesion can be identified, or a resolving, or worsening lesion clearly delineated, so that a certainty of diagnostic evaluation can be obtained, clearly noted and the observation time recorded. Since only motor and sensory function (intact, partial, complete) are shown in the neurologic figure, proprioceptor function is shown in the chart table indicating side and level. For purposes of demonstration an image is presented (FIG.
  • the information presented in the skeletal image of FIG. 5 can be directly correlated with that presented in the neurologic examination image (FIG. 3). Since any image can be repeated as serial examinations are made and the times of the repeated examinations are automatically recorded, a worsening condition or a favorable response to therapy can be precisely documented. This information could be shared with a remote consultant by a direct network connection or telephone modem so that definitive decision making can be made relevant to the need for patient transfer from a non trauma center to a Level I Trauma Center with neurosurgical capabilities.
  • Skeletal Injuries The presence, location and details of fractures to other bones of the skeletal system can also be indicated (Skeleton), as shown FIG. 5.
  • Skeletal buttons The “hot buttons” and the mouse cursor, the specific location site of fractures, joint sprains, ligament disruptions and dislocations of various bones of the skeletal system including the vertebrae of the cervical, thoracic and lumbar spine, as well as the ribs can be localized (illustratively indicated by yellow triangle) and the type and complexity of the fracture indicated (hot button color).
  • placing the mouse cursor over a given bone region causes the name to light up in the color of the injury type and severity "hot button" designated.
  • the color remains in the designated location and side.
  • other information associated with the fracture injury can be noted with regard to severity staging, so as to facilitate the decision making process regarding the urgency of therapy.
  • segmental bone loss (B), or associated soft tissue loss (T) can be identified, and in very severe injuries any neurologic impairment associated with the specific injury (N) also can be designated.
  • B segmental bone loss
  • T soft tissue loss
  • N neurologic impairment associated with the specific injury
  • FIG. L The presence and location of a traumatic amputation to an extremity can also be shown (black bar).
  • All of these data can in turn be related to the information contained in the other imaging diagrams, such as the presence or absence of peripheral pulses and the extremity ABI requested in the Vascular images (Vase). This permits the examiner to relate the surface injury characteristics to the fracture or ligamentous dislocation injuries of the underlying skeletal structures and any vascular or neurologic consequences.
  • the thoracic and abdominal viscera are displayed for localization of injury by type of insult and severity grading. While the diagram is a hermaphrodite, the program limits the options with regard to the organs of generation by the designated sex in the original demographic field (i.e. , in males the examiner cannot access the location for uterus, ovaries and vagina and vice versa).
  • the specific severity grading qualifications for each particular organ are presented in a pop-up window as that organ or organ region (e.g. , right lobe of liver) is chosen.
  • this figure shows a trans diaphragmatic thoraco- abdominal gunshot wound, with entry into the lower lobe of the right lung, trans diaphragmatic entry into the right lobe of the Liver, with exit in the middle segment (middle lobe) of the left lobe of the Liver, entry into and exit from the body of the stomach, a through and through perforation of the transverse colon and a hematoma of the spleen.
  • Each injury is graded according to the Moore et al (4-7) severity scheme.
  • the screen of FIG. 7 presents the retroperitoneal organs and their major vascular supply using the same conventions as above.
  • FIG. 9 shows the anatomic scheme of the major arterial system, including the intra-cranial vessels, with each major segment or division designated.
  • the exact site of injury and its cause can be localized by the mechanism "hot buttons" and the severity of injury designated by the Moore et al (4-7) system of grading using a pop-up window.
  • the presence or absence of peripheral arterial pulses can be indicated as well as the ABI index for the extremities.
  • Information from this diagram can be correlated with surface injuries noted in the Skin/Body diagram for that patient (FIG. 1 screen) and with that patient's skeletal injuries (FIG. 4 screen).
  • This screen diagram (which is not shown in the figures) demonstrates all of the anatomic segments of the right and left lungs, from frontal, posterior, lateral and medial (hilar) aspects, as well as the major divisions of the trachea bronchial tree. It allows not only for localization of penetrating injuries, but also for delineation of areas of lung contusion, pneumonitis, ARDS Abscess and empyema. It also permits the recording of localization of foreign bodies, or lacerations in the tracheobronchial tree as found by bronchoscopy.
  • additional anatomic screens may readily be designed and implemented to provide detailed recording of other injury conditions, such as peripheral nerve injuries, more detailed orthopedic injury descriptions, injuries to the pelvis and its critical vasculature relevant to pelvic fracture mechanisms, the detailed anatomy of the spine, the thoracic cardiovascular anatomy and that of the intrathoracic esophagus, the neck, and the brain and its coverings, as well as critical body cross sections compatible with the recovery of computer tomographically delineated organ injuries.
  • injury conditions such as peripheral nerve injuries, more detailed orthopedic injury descriptions, injuries to the pelvis and its critical vasculature relevant to pelvic fracture mechanisms, the detailed anatomy of the spine, the thoracic cardiovascular anatomy and that of the intrathoracic esophagus, the neck, and the brain and its coverings, as well as critical body cross sections compatible with the recovery of computer tomographically delineated organ injuries.
  • the invention facilitates a designation of the utilization of standard acute resuscitative and emergency surgical procedures and their CPT codes.
  • This Resuscitation Critical Care pop-up window is activated by placing the cursor in the Sx box in FIG. 1, after the mandatory examinations (Screens 1-4) are completed.
  • the original injury screens FIGs. 2-9 will be returned with the designated injuries noted.
  • a pop-up window shows the injury name and ICD.9 code.
  • a second pop-up window below the injury designation screen presents a list of trauma related surgical procedures for that organ or structure and their CPT codes ⁇ fees for each code can also be added to assist the billing process.
  • the procedure performed for that organ is then designated by touching its name with the mouse cursor, this then links the organ injury and severity grade and its ICD.9 code with the chosen surgical procedure and its CPT code.
  • a format for demographic patient information which can be entered by a record clerk in the Patient Admitting Area contains data concerning the patient's name, address, social security number, hospital record number, insurance information and billing address, as well as information concerning the patient's chief complaint, mode of entry into the hospital and condition at the time of entry. Also, other relevant admission information can be entered. These data can be transferred through the data base to the anatomic screens, so that the physician only needs to enter the clinical information. These data are also available to the operative note and billing information screen.
  • the procedure and operative note section of the program allows the linkage of the patient's diagnostic information to therapeutic information regarding specific procedures or operations performed on the patient.
  • the screen displaying Patient Reporting is set forth in FIGS. 13A and 13B.
  • the primary patient data from the demographic information is automatically entered in the operative note.
  • the surgeon then has the option of designating which type of category of procedures he is dealing with (e.g. , resuscitation, trauma consultation, critical care, closure of superficial lacerations and plastic reconstructive procedures, and various major operations by region of the body, including the nature and location of body incisions.
  • these data have been linked to the ICD.9 code, they can be verified by the operating surgeon directly on the screen display.
  • FIG. 11 shows a pop-up window listing the fractures sustained by a Motor Vehicle Crash (MVC) study patient for use in a screen diagram of the interior of the front seat passenger compartment of a motor vehicle.
  • MVC Motor Vehicle Crash
  • This particular screen display comports with parameters described in a National Highway Traffic Safety supported study of Motor Vehicle Crashes (10).
  • This image also allows information about the driver or passenger status of the victim, the direction of the MVC crash, the victim's use of restraints and their type, and the consequences of the crash to the vehicle with regard to the passenger compartment integrity.
  • the multi-patient data base can also be migrated to one of the standard statistical data bases (e.g. , SAS, SPSS) for statistical analysis.
  • standard statistical data bases e.g. , SAS, SPSS
  • a series of therapeutic advisories has been developed in conjunction with the system of the invention to relate the medical and surgical recommendations for initial therapy to the specific types, location and severities of injuries delineated in the diagnostic examination diagrams. These data are based on the primary data entered and can be brought to the examiners attention by activating the Rx advice box present on each body image diagram. An example of a portion of one such therapeutic advisory is shown in FIGs 12 a, b & c. While these specific advisories are based on presently developed protocols, they can be changed as new information or new therapeutic regimens are developed, so as to maintain the advice as current as possible.
  • FIG. 12 the recommended fluid therapy for the mock patient, Joseph Smith, age 44, weight 100 kilograms, height 6'2", sex male, shown in FIG. 1, are presented.
  • the illustrative bu trauma was secondary to flame with a electrical component.
  • the percentage of first, second and third degree bums are shown in FIG. 1 and the percentage of the second and third degree bums have been cumulated as a basis for fluid therapy.
  • FIG. 12A where the basic data are repeated, the body surface area is computed and the fluid requirements for the first and second 24 hours are shown based on a modified Brooke Army Bum Center protocol. (However, if desired, an altemate protocol, such as the Parkland formulation can be substituted).
  • crystalloid fluid replacement therapy only is used during the initial 24 hours of treatment and a combination of crystalloid and colloid fluid therapy is used in the second 24 hour period.
  • the program computes the volumes and the rates of fluid administration as a baseline. Note that therapeutic advisories are also shown which indicate that the baseline rate of fluid administration is to be adjusted to maintain vital signs and to keep the urine output between 50-100 milliliters per hour. Cautions regarding the use of dextrose: salt solution modifications in the replacement fluid therapy appropriate to the patient's needs are discussed.
  • FIG. 12B A conditional requirement for physiologic monitoring of patients with large bums, the percent bum sustained by Mr. Smith (40.9 percent) is noted, and the use and body weight adjusted dosage of inotropic agents to maintain a high cardiac output in the hyperdynamic range are shown (FIG. 12B).
  • the use of agents to combat excessive vasoconstriction is noted and specific cautions as to when to obtain serial chest x-rays to evaluate fluid overload by pulmonary infiltration are shown.
  • the need for frequent monitoring of plasma electrolytes, glucose and blood urea nitrogen, as well as blood gases is noted and their frequency indicated.
  • DI diabetes insipidus
  • MOORE E.E., COGBILL, T.H. , MALANGONI, M.A. , et. al. Organ Injury Scaling, II: Pancreas, Duodenum, Small Bowel Colon, and Rectum. J. Trauma 30: 1427-1429, 1990.
  • SIEGEL, J.H. , STROM, B.L. The computer as a "living textbook” applied to the care of the critically injured patient. J. Trauma 12:739-751, 1992.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Epidemiology (AREA)
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  • Medical Informatics (AREA)
  • Primary Health Care (AREA)
  • Public Health (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)

Abstract

Procédé informatique graphique interactf, permettant à un chirurgien de médecine ou de traumatologie d'utiliser une série d'images anatomiques pour déterminer l'emplacement, la nature, la complexité et la gravité de traumatismes à l'aide d'une interface, par exemple du type souris. Ce procédé comporte, comme première interface homme/machine, une série d'images couleur affichées partageant une base de données commune, lesdites images comprenant: (1) la peau et les tissus superficiels (pour localiser les emplacements et la nature des lésions ou des brûlures), (2) le crâne, les os du visage, l'examen neurologique du SNC comportant un calcul automatique de l'échelle de coma de Glasgow (GCS), (3) l'anatomie du squelette et des articulations (pour les lésions orthopédiques), (4) l'examen de la moelle épinière, (5) les viscères thoraco-abdominales, (6) les voies hépatiques, pancréatiques et biliaires, (7) les organes et structures rétropéritonéales, (8) le système vasculaire, (9) les poumons et l'arbre thrachéo-bronchique. Après introduction des données, les lésions peuvent être groupées en vue de leur enregistrement et de leur codage (par exemple: fractures, lésions aux organes, lacérations etc.) Pour certaines lésions spécifiques, le système détermine les critères de gravité, formule des directives de procédures thérapeutiques, et fournit des suggestions de thérapies ayant cours et des précautions à prendre.
PCT/US1995/016611 1994-12-19 1995-12-19 Systeme interactif a interface graphique pour l'assistance au personnel medical en vue du diagnostic, du traitement et du suivi de patients operes ou souffrant d'un traumatisme WO1996019774A1 (fr)

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EP1271384A1 (fr) * 2001-06-28 2003-01-02 Boehringer Ingelheim International GmbH Système et méthode d'assistance pour le diagnostic, la thérapie et la surveillance d'une maladie pulmonaire fonctionnelle
WO2003067503A2 (fr) * 2002-02-07 2003-08-14 Decode Genetics Ehf. Expert conseil medical
WO2003067503A3 (fr) * 2002-02-07 2004-07-01 Decode Genetics Ehf Expert conseil medical
US8090440B2 (en) 2003-04-02 2012-01-03 Physio Control, Inc. Defibrillators customized for anticipated patients
US8090441B2 (en) 2003-04-02 2012-01-03 Physio Control, Inc. Defibrillators customized for anticipated patients
US8090439B2 (en) 2003-04-02 2012-01-03 Physio Control, Inc. Defibrillators customized for anticipated patients
US7623915B2 (en) 2003-07-16 2009-11-24 Medtronic Physio-Control Corp. Interactive first aid information system
WO2005011487A1 (fr) * 2003-07-31 2005-02-10 Medtronic Emergency Response Systems, Inc. Protocoles d'examen, d'evaluation et de traitement de lesion cerebrale
WO2006065374A1 (fr) * 2004-12-16 2006-06-22 Siemens Medical Solutions Usa,Inc. Systeme d'acquisition de donnees medicales graphiques
US8063915B2 (en) 2006-06-01 2011-11-22 Simquest Llc Method and apparatus for collecting and analyzing surface wound data
EP2029005A4 (fr) * 2006-06-01 2010-06-09 Simquest Llc Procede et appareil de collecte et d'analyse de donnes concernant des lesions de surface
EP2029005A2 (fr) * 2006-06-01 2009-03-04 Simquest LLC Procede et appareil de collecte et d'analyse de donnes concernant des lesions de surface
US9984415B2 (en) 2009-09-24 2018-05-29 Guidewire Software, Inc. Method and apparatus for pricing insurance policies
US11080790B2 (en) 2009-09-24 2021-08-03 Guidewire Software, Inc. Method and apparatus for managing revisions and tracking of insurance policy elements
US11900472B2 (en) 2009-09-24 2024-02-13 Guidewire Software, Inc. Method and apparatus for managing revisions and tracking of insurance policy elements
WO2012173717A1 (fr) * 2011-06-17 2012-12-20 Covidien Lp Système d'évaluation vasculaire
US9202012B2 (en) 2011-06-17 2015-12-01 Covidien Lp Vascular assessment system
US20220189594A1 (en) * 2014-07-15 2022-06-16 T6 Health Systems Llc Healthcare information analysis and graphical display presentation system

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