April 2006

Column Editor - Tom Stibolt

I have downloaded a number of decision aids for my PDA. I suspect this is an area where much growth is possible. At their core, decision aids implement a model of a disease process. They often elicit information from the user and suggest next steps or likelihood of a specific diagnosis.

My first example is a specific sepsis evaluation tool from the Technology Assessment Unit affiliated with the University of Toronto. Development of this tool was undertaken with outside developer, Infinique. The program is free, but needs to be registered for continued use. The decision tool offers an evaluator with checkboxes for critical patient findings and determines whether the patient has septic shock and how many organ systems have evidence of dysfunction. The tool is easy to use and can replace the Society of Critical Care Medicine Pocket Card used for this same purpose. The tool also has the guidelines for early gola directed therapy and calculators for several severity of illness scores including apache II, SAPS II, SOFA and MODS. The software works on both PalmOS and Windows Mobile devices and is available at www.medtau.org.

Next is a decision tool from the AmericanCollege of Physicians that includes two aids. The first is a tool for determining the likelihood that a patient has SARS and then suggests a test strategy to confirm or exclude the diagnosis. The second is a tool to predict the likelihood of malignancy for a solitary pulmonary nodule. The latter helps determine the pre-test probability and then suggests a workup strategy. Both of these aids are contained in a single package and the ACP automatically enforces an expiration date so that the tool will be kept up to date. The software is free, although registration is required. It is only available for PalmOS devices. You can find it at www.annals.org/pda .

Another tool also from the AmericanCollege of Physicians is a bioterrorism diagnostic aid. It includes modules for evaluating possible Smallpox, Anthrax (both inhalational and cutaneous) and chemical exposure. A radiation module is apparently in the works. The modules vary from highly specific questions to general information to help with decision making. It also provides recommendations for quarantine, treatment when appropriate and additional testing. It references images on the web to help in diagnosis. The software is available for free from www.acponline.org/bioterro/ which also includes a wealth of online bioterrorism references and links to other important sites. It appears the modules are being updated infrequently with the last update in 2003. The only version available at the present time is for PalmOS.

Finally, there is a tool called MedRules written by Dr. Kent Willyard. It is currently in version 3.3 and includes rules for 40 conditions. Although only two are pulmonary, Community-Acquired Pneumonia and Probability of Pulmonary Embolism. It was written in 2003 and is based on articles, which are cited from the 1980s through 2000. The CAP rule is an implementation of the algorithm in the New England Journal of Medicine in 1997 to determine the need for hospitalization. It has no antibiotic recommendations. The Pulmonary Embolism risk rule is based on the clinical model published in 2000 in Thrombosis and Haemostasis. It gives the likelihood of PE and adjusted risk based on D-dimer, but no treatment suggestions. The software is free and appears only available for PalmOS devices. It is available from a variety of sources such as www.medtau.org. This might be a good piece of software that you can recommend to friends in primary care or Obstetrics and Gynecology.

If you have encountered other helpful aids, please feel free to let me know about them.

The opinions rendered herein are those of the author; no representation, warranty of guarantee of fitness is either made or implied.