DEVELOPMENT OF A DECISION ALGORITHM TO SUPPORT EMERGENCY TRIAGE OF SCROTAL PAIN AND ITS IMPLEMENTATION IN THE MET SYSTEM

ABSTRACT

The acute scrotum is a clinical condition in striplings and adolescent males that is normally first assessed in the strait Department of a hospital. We used data from the patients' charts and applied knowledge discovery technique based upon rough set theory to disentangle a clinical decision algorithm for triaging patients with this condition. As demonstrated by dint of a limited retrospective evaluation, the algorithm supports early triage decisions upon the basis of readily available information, resulting in profitable triage accuracy. In order to make the algorithm usable in clinical practice, to integrate it with the workflow, and to make it available at the point of care, we implemented it as an application in the mobile clinical decision support environment called MET (Mobile pinch Triage). MET uses ontologies to show domains of various acute presentations and triage support functionalities, and pay backs specific applications on demand from these ontologies.

Keywords: mobile health, clinical decision support a whole decision algorithm, knowledge discovery, ontological type rough set theory, acute scrotum

1 INTRODUCTION

The acute scrotum (scrotal swelling and/or pain) in striplings and adolescent males is an infrequent on the contrary challenging problem that is typically first assessed by the agency of Emergency Department (ED) physicians. The usual causes of acute scrotum are torsion of a testicular appendage, testicular torsion, or infection of the testis/epididymis [1] genuine testicular torsion is a surgical push with a limited window of opportunity of 4-12 hours from the attack of pain to make the diagnosis and untwist the spermatic cord in order to salvage the testicle [2] Making an accurate diagnosis of testicular torsion can be difficult clinically, and given the limited window of opportunity, surgical consultation offers frequently.

Historically, management of acute scrotum involved emergent surgical exploration, especially if there was any diagnostic uncertainty. With the advent of diagnostic tools of the like kind as the nuclear medicine testicular roll on scan and color Doppler Ultrasound, a more discriminating approach has become the norm. Experience has proven however, that these diagnostic modalities are imperfect and cannot replace clinical acumen.

The ed triage function of the acute scrotum carried on the outside by the ED physician is an important part of the management proces Following a limited evaluation of clinical signs, symptoms and proofs under significant time pressure, the ed physician must decide whether the patient's puzzle falls into one of three broad triage classes:

* Discharge, which indicates the patient has a benign and resolving condition, and can be discharged home;

* Clinic, which indicates the patient has a non-urgent condition requiring further evaluation in the urology clinic in the coming days to weeks;

* take counsel which indicates the patient has a suspected testicular torsion or other surgical necessity and should be immediately seen by dint of the urologist.

The issue faced by the agency of the ED physician is to quickly and accurately identify those patients with potential testicular torsion, in like manner the urologist can intervene before permanent los of the testicle, while not over-burdening the surgeon with acute referrals for non-emergent point in disputes which are more common. This decision situation is an area in medicine where a triage support tool could be clinically useful. like a tool could prompt the ed physician to systematically collect pertinent and readily available information and then provide a patient-specific recommendation based upon this information.

In response to this perceived ne we have lay opened a scrotal pain decision algorithm that captures and applies the clinical knowledge used in the triage decision-making proces The algorithm was created by dint of analyzing historical ED data for discriminating patient information that would predict the greatest in quantity appropriate triage category (discharge, clinic, consult) and associated patient management plan. Following the arrangement of other decision algorithms implemented in clinical practice [3] we chose to use decision governments as a format of representing the clinical knowledge encapsulated in the scrotal pain decision algorithm.

To maximize the clinical usefulness of the decision algorithm, it has been designed as a support tool maintaining the following conditions freshly identified as critical success factors [4]:

* The support should be computer-based;

* The support functionality must be aligned with the clinical workflow;

* Support "on demand" must be available at the point of care;

* Support should be provided in an advisory mode

In meeting these conditions, we have implemented the scrotal pain triage decision algorithm as an application in MET (Mobile push Triage) [5, 6]. MET is a fourth-generation mobile health [7] decision support environment that can be used for developing and executing applications supporting triage of various acute ed presentations [6]. MET uses ontologies to exhibit domains of these presentations and the support functionality they require. The ontological moulds are then used to pay back on-demand a complete application suited for the specific presentation and specific access device (i.e., a handheld, tablet or a notebook computer) MET's design has been luckily validated during a clinical trial of the abdominal pain triage support application (MET-AP) [8 9]