Guiding Principles for a Pediatric Neurology ICU (neuroPICU) Bedside Multimodal Monitor

Zachary M Grinspan; Yonina C. Eldar; Daniel Gopher; Amihai Gottlieb; Rotem Lammfromm; Halinder S Mangat; Nimrod Peleg; Steven Pon; Igal Rozenberg; Nicholas D Schiff; David E Stark; Peter Yan; Hillel Pratt; Barry E Kosofsky

doi:10.4338/ACI-2015-12-RA-0177

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2016; 07(02): 380-398
DOI: 10.4338/ACI-2015-12-RA-0177

Research Article

Schattauer GmbH

Guiding Principles for a Pediatric Neurology ICU (neuroPICU) Bedside Multimodal Monitor

Findings from an International Working Group

Zachary M Grinspan

¹Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY

²Department of Pediatrics, Weill Cornell Medicine, New York, NY

³New York-Presbyterian Hospital, New York, NY

,

Yonina C. Eldar

⁴Faculty of Electrical Engineering, Technion Israel Institute of Technology, Haifa, Israel

,

Daniel Gopher

⁵Faculty of Industrial Engineering and Management, Technion Israel Institute of Technology, Haifa, Israel

,

Amihai Gottlieb

⁵Faculty of Industrial Engineering and Management, Technion Israel Institute of Technology, Haifa, Israel

,

Rotem Lammfromm

⁵Faculty of Industrial Engineering and Management, Technion Israel Institute of Technology, Haifa, Israel

,

Halinder S Mangat

³New York-Presbyterian Hospital, New York, NY

⁶Department of Neurology, Weill Cornell Medicine, New York, NY

,

Nimrod Peleg

⁴Faculty of Electrical Engineering, Technion Israel Institute of Technology, Haifa, Israel

,

Steven Pon

²Department of Pediatrics, Weill Cornell Medicine, New York, NY

³New York-Presbyterian Hospital, New York, NY

,

Igal Rozenberg

⁴Faculty of Electrical Engineering, Technion Israel Institute of Technology, Haifa, Israel

,

Nicholas D Schiff

³New York-Presbyterian Hospital, New York, NY

⁶Department of Neurology, Weill Cornell Medicine, New York, NY

⁷Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY

,

David E Stark

⁹Departments of Medicine and Bioengineering, Stanford University, Stanford, CA

,

Peter Yan

³New York-Presbyterian Hospital, New York, NY

⁶Department of Neurology, Weill Cornell Medicine, New York, NY

,

Hillel Pratt

⁸Faculties of Medicine and Biomedical Engineering, Technion Israel Institute of Technology, Haifa, Israel

,

Barry E Kosofsky

²Department of Pediatrics, Weill Cornell Medicine, New York, NY

³New York-Presbyterian Hospital, New York, NY

⁶Department of Neurology, Weill Cornell Medicine, New York, NY

⁷Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY

› Author Affiliations

Abstract

Summary

Background

Physicians caring for children with serious acute neurologic disease must process overwhelming amounts of physiological and medical information. Strategies to optimize real time display of this information are understudied.

Objectives

Our goal was to engage clinical and engineering experts to develop guiding principles for creating a pediatric neurology intensive care unit (neuroPICU) monitor that integrates and displays data from multiple sources in an intuitive and informative manner.

Methods

To accomplish this goal, an international group of physicians and engineers communicated regularly for one year. We integrated findings from clinical observations, interviews, a survey, signal processing, and visualization exercises to develop a concept for a neuroPICU display.

Results

Key conclusions from our efforts include: (1) A neuroPICU display should support (a) rapid review of retrospective time series (i.e. cardiac, pulmonary, and neurologic physiology data), (b) rapidly modifiable formats for viewing that data according to the specialty of the reviewer, and (c) communication of the degree of risk of clinical decline. (2) Specialized visualizations of physiologic parameters can highlight abnormalities in multivariable temporal data. Examples include 3-D stacked spider plots and color coded time series plots. (3) Visual summaries of EEG with spectral tools (i.e. hemispheric asymmetry and median power) can highlight seizures via patient-specific “fingerprints.” (4) Intuitive displays should emphasize subsets of physiology and processed EEG data to provide a rapid gestalt of the current status and medical stability of a patient.

Conclusions

A well-designed neuroPICU display must present multiple datasets in dynamic, flexible, and informative views to accommodate clinicians from multiple disciplines in a variety of clinical scenarios.

Keywords

Pediatric intensive care units [N02.278.388.493.390] - neurology [H02.403.600] - biomedical engineering [H02.070] - informatics [L01.313] - data display [F02.784.412.221]

Full Text

References

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