Development Of Knowledge-Based Clinical Decision Support System For Patients Included In Colorectal Screening Program

Aims Clinical Decision Support Systems (CDSSs) have recently attracted attention as a method for minimizing medical errors.Colorectal (CRC) screening programs represent a large volume of procedures that need a follow-up endoscopy. A knowledge-based CDDS (K-CDSS) is a technology which contains clinical rules and associations of compiled data that assist with clinical decision-making tasks. Existing CDSSs are limited. To overcome this limitation we develop a K-CDSS based on variables and clinical rules introduced by medical specialist for management of patients included in CRC screening and surveillance of colorectal polyps.

Methods We collected information on 48 variables from hospital colonoscopy records at a single centre in Spain between September 2020 and October 2020. Using DILEMMA Solutions (https://www.dilemasolution.com) we developed the prototype K-CDSS (PoliCare), to provide tailored recommendations by combining patients data and current guidelines recommendations. The accuracy of rules was verified using four scenarios (normal colonoscopy, lesions different than polyps, non-advanced adenomas and advanced adenomas). We studied the degree of agreement between the clinical assessments made by expert doctors and nurses equipped with K-CDSS. Two experts confirmed a correlation between guidelines and PoliCare recommendations.

Results 56 consecutive endoscopy cases from colorectal screening program were included (62.8 years; range 53-71). Colonoscopy results were: absence of colon lesions (n = 7, 12.5 %), lesions in the colon that are not polyps (n = 3, 5.4 %) and resected colonic polyps (n = 46, 82.1 %; 100 % R0 resection). Patients with resected polyps presented non-advanced adenoma (n = 21, 45.6 %) or advanced lesions (n = 25, 54.4 %). There were no differences in erroneous orders with Policare (Kappa value 1.0).

Conclusions The use of K-CDSS can easily integrated into the workflow and can be carry out by endoscopy nursery to manage patients included in CRC screening and surveillance of colorectal polyps.

Citation Lorenzo-Zúñiga V, Bustamante-Balén M, Argüello L et al. eP477 DEVELOPMENT OF KNOWLEDGE-BASED CLINICAL DECISION SUPPORT SYSTEM FOR PATIENTS INCLUDED IN COLORECTAL SCREENING PROGRAM. Endoscopy 2021; 53: S254.