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Acute care systems
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ACORN
Admit to the Ccu OR Not |
Hybrid rule-based & Bayesian system for advising on management of chest pain patients in the emergency room.
| developed by |
clinical domains |
keywords |
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Management of chest pain patients in the emergency room |
Hybrid, rule-based, Bayesian, decision support system |
| location |
commissioned |
status |
| Accident & Emergency Department, Westminster Hospital, London |
1987 |
Decommissioned 1990 |
| description |
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Medical audits determined that 38% of patients attending with acute ischaemic heart disease were sent home in error and the median time till CCU admission for the remainder was 115 minutes. ACORN, a hybrid backward- chaining rule-based and Bayesian system, was built for use by senior nurses to assist in the management of these patients. In a randomised controlled trial on 150 patients in 1987 the false negative rate in both control & ACORN cases fell to 20%; this may have been a carryover or Hawthorne effect. This trial also identified significant problems with ACORN, and it was subsequently revised and appeared to be effective at reducing the median time to CCU admission by 20 minutes, though this was an uncontrolled study.
The system was in routine use at Westminster during 1987-90. In 1990: the mean usage rate per eligible case claimed by the 15 users was 77%, but when unequivocal evidence of use was looked for in the patient records, this was present in only 23% of eligible cases. There were approx. 15 eligible cases per week = 750 per year, so this scales up to between 175 and 580 uses of ACORN per annum.
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| references |
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Wyatt J. "The evaluation of clinical decision aids: a discussion of methodology used in the ACORN project", Lecture Notes in Medical Informatics 1987; 33: 15- 24.
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Wyatt J (1989). Lessons learned from the field trial of ACORN, an expert system to advise on chest pain. In: Barber B, Cao D, Qin D, eds. Proc. Sixth World Conference on Medical Informatics, Singapore. Amsterdam: North Holland 1989: 111-115
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Emerson PA, Russell NR, Wyatt JC et al. (1989). An audit of the management of patients attending an accident and emergency department with chest pain. Quart J Med 1989; 70: 213-220
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Wyatt J, Spiegelhalter D. Field trials of medical decision-aids: potential problems and solutions. In Clayton P (ed). Proc. 15th Symposium on Computer Applications in Medical Care, Washington 1991. New York: McGraw Hill Inc. 1991: 3-7
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Wyatt J. "Computer-based knowledge systems". The Lancet 1991; 338: 1431-1436
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Heathfield HA, Wyatt J. Philosophies for the design and development of clinical decision-support systems. Meth Inform Med 1993; 32:1-8
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Wyatt J, Spiegelhalter D. The evaluation of medical expert systems. In: Evans D, Patel V (eds), Advanced models of cognition for medical training and practice. MIT Press, 1992 (NATO ASI series F97): 101-120
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| contact |
links |
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Web: Jeremy Wyatt
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| acknowledgements |
Archive of AI systems in clinical practice previously administered by Enrico Coiera. Used with permission. Maintained and extended since 2001 by OpenClinical. |
Entry on archive: March 26 1993
Last updated: June 1 2001
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