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.

  • References

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  • 24 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Critical care medicine 1996; 24 (05) 743-752 PubMed PMID: 8706448.
  • 25 Liu V, Turk BJ, Ragins AI, Kipnis P, Escobar GJ. An electronic Simplified Acute Physiology Score-based risk adjustment score for critical illness in an integrated healthcare system. Critical care medicine 2013; 41 (01) 41-48 PubMed PMID: 23222263.
  • 26 Wilkinson L, Wills G. The grammar of graphics. 2nd. ed. New York: Springer; 2005. xviii 690.
  • 27 Starren J, Johnson SB. An object-oriented taxonomy of medical data presentations. J Am Med Inform Assoc 2000; 07 (01) 1-20 PubMed PMID: 10641959. Pubmed Central PMCID: 61451.
  • 28 Sebastian K, Sari V, Loy LY, Zhang F, Zhang Z, Feng M. Multi-signal Visualization of Physiology (MVP): a novel visualization dashboard for physiological monitoring of Traumatic Brain Injury patients. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Conference 2012; 2012: 2000-3 PubMed PMID: 23366310.
  • 29 Bennett KB, Flach JM. Graphical Displays – Implications for Divided Attention, Focused Attention, and Problem-Solving. Hum Factors 1992; 34 (05) 513-533 PubMed PMID: WOS:A1992KA54500002.
  • 30 Wickens CD, Merwin DH, Lin EL. Implications of Graphics Enhancements for the Visualization of Scientific-Data – Dimensional Integrality, Stereopsis, Motion, and Mesh. Hum Factors 1994; 36 (01) 44-61 PubMed PMID: WOS:A1994NN52200003.
  • 31 Abend NS, Chapman KE, Gallentine WB, Goldstein J, Hyslop AE, Loddenkemper T, Nash KB, Riviello Jr JJ, Hahn CD. Pediatric Critical Care EEGG, the Critical Care EEGMRC. Electroencephalographic monitoring in the pediatric intensive care unit. Current neurology and neuroscience reports 2013; 13 (03) 330 PubMed PMID: 23335026. Pubmed Central PMCID: 3569710.
  • 32 Hansen JP. An experimental investigation of configural, digital, and temporal information on process displays. Hum Factors 1995; 37 (03) 539-552 PubMed PMID: WOS:A1995TN43600006.
  • 33 Carswell CM, Wickens CD. Mixing and matching lower-level codes for object displays: Evidence for two sources of proximity compatibility. Hum Factors 1996; 38 (01) 1-22 PubMed PMID: WOS:A1996UP37500001.
  • 34 Drews FA, Westenskow DR. The right picture is worth a thousand numbers: Data displays in anesthesia. Hum Factors 2006; Spr; 48 (01) 59-71 PubMed PMID: WOS:000237042500007.

Correspondence to:

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

  • References

  • 1 LaRovere KL, Riviello Jr JJ. Emerging subspecialties in neurology: building a career and a field: pediatric neurocritical care. Neurology 2008; 70 (22) e89-91 PubMed PMID: 18505973.
  • 2 Scher M. Proposed cross-disciplinary training in pediatric neurointensive care. Pediatr Neurol 2008; 39 (01) 1-5 PubMed PMID: 18555165. Epub 2008/06/17.
  • 3 Murphy S. Pediatric neurocritical care. Neurotherapeutics 2012; 09 (01) 3-16 PubMed PMID: 22183817. Pubmed Central PMCID: 3271153. Epub 2011/12/21.
  • 4 Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS, Warden CR. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med 2012; 13 (Suppl. 01) S1-S82 PubMed PMID: 22217782. Epub 2012/01/11.
  • 5 Stein SC, Georgoff P, Meghan S, Mirza KL, El Falaky OM. Relationship of aggressive monitoring and treatment to improved outcomes in severe traumatic brain injury. Journal of neurosurgery 201; 112 (05) 1105-1112 PubMed PMID: 19747054. Epub 2009/09/15.
  • 6 Geri N, Geri Y. The Information Age Measurement Paradox: Collecting Too Much Data. Informing Science 2011; 14: 47-59.
  • 7 Ahmed AH, Giri J, Kashyap R, Singh B, Dong Y, Kilickaya O, Erwin PJ, Murad MH, Pickering BW. Outcome of Adverse Events and Medical Errors in the Intensive Care Unit: A Systematic Review and Metaanalysis. American journal of medical quality: the official journal of the American College of Medical Quality. 2013 Dec 19. PubMed PMID: 24357344.
  • 8 Wusthoff CJ, Shellhaas RA, Clancy RR. Limitations of single-channel EEG on the forehead for neonatal seizure detection. J Perinatol 2009; 29 (03) 237-242 PubMed PMID: 19052554. Epub 2008/12/05.
  • 9 Akman CI, Micic V, Thompson A, Riviello Jr JJ. Seizure detection using digital trend analysis: Factors affecting utility. Epilepsy Res 2011; 93 (01) 66-72 PubMed PMID: 21146370. Epub 2010/12/15.
  • 10 Sackellares JC, Shiau DS, Halford JJ, LaRoche SM, Kelly KM. Quantitative EEG analysis for automated detection of nonconvulsive seizures in intensive care units. Epilepsy Behav 2011; 22 (Suppl. 01) S69-S73 PubMed PMID: 22078521. Epub 2011/12/07.
  • 11 Akman CI, Riviello Jr JJ. Generalized periodic epileptiform discharges in critically ill children: a continuum of status epilepticus or an epiphenomenon?. J Clin Neurophysiol 2011; 28 (04) 366-372 PubMed PMID: 21811125. Epub 2011/08/04.
  • 12 Snodgrass SM, Tsuburaya K, Ajmone-Marsan C. Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus. J Clin Neurophysiol 1989; 06 (02) 159-172 PubMed PMID: 2708516. Epub 1989/04/01.
  • 13 Health USDo, Human Services USA. Protecting the privacy of patients’ health information. Summary of the final regulation. Health care law monthly. 2000: 20-24 PubMed PMID: 11924156.
  • 14 Tuckett AG. Applying thematic analysis theory to practice: a researcher’s experience. Contemporary nurse 2005; 19 1–2): 75-87 PubMed PMID: 16167437.
  • 15 Gershon GulritE. Haifa, Israel: Technion Institute of Technology; 2013
  • 16 van Putten MJ. The colorful brain: visualization of EEG background patterns. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society 2008; 25 (02) 63-68 PubMed PMID: 18340270.
  • 17 Spooner SA. Special requirements of electronic health record systems in pediatrics. Pediatrics 2007; 119 (03) 631-637 PubMed PMID: 17332220. Epub 2007/03/03.
  • 18 Hemphill JC, Andrews P, De Georgia M. Multimodal monitoring and neurocritical care bioinformatics. Nature reviews Neurology 2011; 07 (08) 451-460 PubMed PMID: 21750522.
  • 19 Zeng Q, Cimino JJ. A knowledge-based, concept-oriented view generation system for clinical data. Journal of biomedical informatics 2001; 34 (02) 112-128 PubMed PMID: 11515411.
  • 20 Pickering BW, Gajic O, Ahmed A, Herasevich V, Keegan MT. Data utilization for medical decision making at the time of patient admission to ICU. Critical care medicine 2013; 41 (06) 1502-1510 PubMed PMID: 23528804.
  • 21 Siebig S, Kuhls S, Imhoff M, Gather U, Scholmerich J, Wrede CE. Intensive care unit alarms -how many do we need? Critical care medicine. 2010; 38 (02) 451-456 PubMed PMID: 20016379.
  • 22 Mitka M. Joint Commission Warns of Alarm Fatigue Multitude of Alarms From Monitoring Devices Problematic. Jama-J Am Med Assoc 2013; 309 (22) 2315-2316 PubMed PMID: WOS:000320176000003.
  • 23 Akre M, Finkelstein M, Erickson M, Liu M, Vanderbilt L, Billman G. Sensitivity of the pediatric early warning score to identify patient deterioration. Pediatrics 2010; 125 (04) e763-e769 PubMed PMID: 20308222.
  • 24 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Critical care medicine 1996; 24 (05) 743-752 PubMed PMID: 8706448.
  • 25 Liu V, Turk BJ, Ragins AI, Kipnis P, Escobar GJ. An electronic Simplified Acute Physiology Score-based risk adjustment score for critical illness in an integrated healthcare system. Critical care medicine 2013; 41 (01) 41-48 PubMed PMID: 23222263.
  • 26 Wilkinson L, Wills G. The grammar of graphics. 2nd. ed. New York: Springer; 2005. xviii 690.
  • 27 Starren J, Johnson SB. An object-oriented taxonomy of medical data presentations. J Am Med Inform Assoc 2000; 07 (01) 1-20 PubMed PMID: 10641959. Pubmed Central PMCID: 61451.
  • 28 Sebastian K, Sari V, Loy LY, Zhang F, Zhang Z, Feng M. Multi-signal Visualization of Physiology (MVP): a novel visualization dashboard for physiological monitoring of Traumatic Brain Injury patients. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Conference 2012; 2012: 2000-3 PubMed PMID: 23366310.
  • 29 Bennett KB, Flach JM. Graphical Displays – Implications for Divided Attention, Focused Attention, and Problem-Solving. Hum Factors 1992; 34 (05) 513-533 PubMed PMID: WOS:A1992KA54500002.
  • 30 Wickens CD, Merwin DH, Lin EL. Implications of Graphics Enhancements for the Visualization of Scientific-Data – Dimensional Integrality, Stereopsis, Motion, and Mesh. Hum Factors 1994; 36 (01) 44-61 PubMed PMID: WOS:A1994NN52200003.
  • 31 Abend NS, Chapman KE, Gallentine WB, Goldstein J, Hyslop AE, Loddenkemper T, Nash KB, Riviello Jr JJ, Hahn CD. Pediatric Critical Care EEGG, the Critical Care EEGMRC. Electroencephalographic monitoring in the pediatric intensive care unit. Current neurology and neuroscience reports 2013; 13 (03) 330 PubMed PMID: 23335026. Pubmed Central PMCID: 3569710.
  • 32 Hansen JP. An experimental investigation of configural, digital, and temporal information on process displays. Hum Factors 1995; 37 (03) 539-552 PubMed PMID: WOS:A1995TN43600006.
  • 33 Carswell CM, Wickens CD. Mixing and matching lower-level codes for object displays: Evidence for two sources of proximity compatibility. Hum Factors 1996; 38 (01) 1-22 PubMed PMID: WOS:A1996UP37500001.
  • 34 Drews FA, Westenskow DR. The right picture is worth a thousand numbers: Data displays in anesthesia. Hum Factors 2006; Spr; 48 (01) 59-71 PubMed PMID: WOS:000237042500007.