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On-line decision support for emergency trauma management.

The overall goal of the TraumAID project is to improve the delivery of quality trauma care during the initial definitive phase of patient management. To this end, we are applying artificial intelligence techniques such as rule-based reasoning, planning, and plan inference. The current system, TraumAID 2.0, consists of (1) an electronic version of the standard trauma flow sheet implemented in HyperCard, that allows information to be entered by a dedicated member of the trauma team called a "scribe nurse" during trauma resuscitation; (2) a rule-based reasoner able to draw diagnostic conclusions from patient findings and test results, and identify what management goals they imply; (3) a planner that takes the set of currently relevant goals and identifies what (partially-ordered) sequence of actions is most appropriate under the circumstances; and (4) two complementary modes ofinformation presentation a graphic display of TraumAID's recommended management plan that can be shown on a monitor positioned in the trauma bay, and a critiquing interface (TraumaTIQ) that uses the goals and plans computed by TraumAID 2.0 to interpret physician orders and comment on them when appropriate. Because both interfaces can present information at a time and place where it could make a difference to the quality and/or cost of patient care, both implement the ideal of realtime quality assurance. Papers describing TraumAID have previously appeared in the literature [1, 2, 3, 4, 5, 7]. TraumAID 2.0 has been validated retrospectively, and its management plans found significantly preferable to actual care [1]. The system is about to be field-tested in the Emergency Center at the Medical College of Pennsylvania (MCP). The system to be field-tested links our HyperCard interface asynchronously to the core system executing in Macintosh Common Lisp on a Quadra 700. The development version, implemented in Lucid Common Lisp within X-Windows on a SPARCserver 690MP, interacts with the developer through a simple Tk/Tcl interface. With respect to our proposed demonstration, we will use segments from videotapes of trauma resuscitations to convey the environment and activities of a trauma team in an Emergency Center, and demonstrate TraumAID's support for data entry during patient management, its capabilities for reasoning and multiple-goal plan formation, and both its graphic and critiquing approaches to real-time information delivery. Such videotapes have been used for educational purposes at the MCP Emergency Center for several years [6].