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
1  Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
2  Department of Pediatrics, Weill Cornell Medicine, New York, NY
3  New York-Presbyterian Hospital, New York, NY
,
Yonina C. Eldar
4  Faculty of Electrical Engineering, Technion Israel Institute of Technology, Haifa, Israel
,
Daniel Gopher
5  Faculty of Industrial Engineering and Management, Technion Israel Institute of Technology, Haifa, Israel
,
Amihai Gottlieb
5  Faculty of Industrial Engineering and Management, Technion Israel Institute of Technology, Haifa, Israel
,
Rotem Lammfromm
5  Faculty of Industrial Engineering and Management, Technion Israel Institute of Technology, Haifa, Israel
,
Halinder S Mangat
3  New York-Presbyterian Hospital, New York, NY
6  Department of Neurology, Weill Cornell Medicine, New York, NY
,
Nimrod Peleg
4  Faculty of Electrical Engineering, Technion Israel Institute of Technology, Haifa, Israel
,
Steven Pon
2  Department of Pediatrics, Weill Cornell Medicine, New York, NY
3  New York-Presbyterian Hospital, New York, NY
,
Igal Rozenberg
4  Faculty of Electrical Engineering, Technion Israel Institute of Technology, Haifa, Israel
,
Nicholas D Schiff
3  New York-Presbyterian Hospital, New York, NY
6  Department of Neurology, Weill Cornell Medicine, New York, NY
7  Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY
,
David E Stark
9  Departments of Medicine and Bioengineering, Stanford University, Stanford, CA
,
Peter Yan
3  New York-Presbyterian Hospital, New York, NY
6  Department of Neurology, Weill Cornell Medicine, New York, NY
,
Hillel Pratt
8  Faculties of Medicine and Biomedical Engineering, Technion Israel Institute of Technology, Haifa, Israel
,
Barry E Kosofsky
2  Department of Pediatrics, Weill Cornell Medicine, New York, NY
3  New York-Presbyterian Hospital, New York, NY
6  Department of Neurology, Weill Cornell Medicine, New York, NY
7  Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY
› Author Affiliations
We are grateful to the Joan and Irwin Jacobs Technion-Cornell Innovation Institute for providing seed funding for this project. This project was supported in part by the National Institute for Neurologic Disease and Stroke grant #K12-NS0662 (ZG).
Further Information

Correspondence to:

Zachary M Grinspan, MD MS
Weill Cornell Medicine
Department of Healthcare Policy & Research
402 East 67th Street
New York
NY 10065

Publication History

received: 21 December 2015

accepted: 29 February 2016

Publication Date:
16 December 2017 (online)

 

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.


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Conflicts Of Interest

The authors declare that they have no conflicts of interest in the research.


Correspondence to:

Zachary M Grinspan, MD MS
Weill Cornell Medicine
Department of Healthcare Policy & Research
402 East 67th Street
New York
NY 10065