DXplain
Encyclopedia
DXplain is a Clinical decision support system
(CDSS) available through the World Wide Web
that assists clinic
ians by generating stratified diagnoses based on user input of patient signs and symptoms, laboratory results, and other clinical findings . Evidential
support for each differential diagnosis
is presented, along with recommended follow-up that may be conducted by the clinician to arrive at a more definitive diagnosis
. The system also serves as a clinician reference with a searchable database
of diseases and clinical manifestations.
, work on DXplain began in 1984 with a first version being released in 1986 .
DXplain contains a database with crude probabilities for over 4,900 clinical manifestations that are associated with over 2,200 unique diseases, yielding a total of over 230,000 unique finding-disease interconnections .
s in clinical rotations, that is not adequately covered by textbook literature . The system's large knowledge base combined with its ability to formulate diagnostic hypotheses have made it a popular education tool for US-based medical schools; by 2005, DXplain was supporting more than 33,189 total users .
. Each clinical finding entered into DXplain is assessed by determining the importance of the finding and how strongly the finding supports a given diagnosis for each disease in the knowledge base
. Using this criterion, DXplain generates ranked differential diagnoses with the most likely diseases yielding the lowest rank. Using stored information regarding each disease’s prevalence and significance, the system differentiates between common and rare diseases.
event, an evaluation of 103 consecutive internal medicine
cases showed that Dxplain correctly identified the diagnosis in 73% of cases, with the correct diagnosis averaging a rank of 10.7 .
Clinical decision support system
Clinical decision support system is an interactive decision support system Computer Software, which is designed to assist physicians and other health professionals with decision making tasks, as determining diagnosis of patient data. A working definition has been proposed by Dr...
(CDSS) available through the World Wide Web
World Wide Web
The World Wide Web is a system of interlinked hypertext documents accessed via the Internet...
that assists clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
ians by generating stratified diagnoses based on user input of patient signs and symptoms, laboratory results, and other clinical findings . Evidential
Evidentiality
In linguistics, evidentiality is, broadly, the indication of the nature of evidence for a given statement; that is, whether evidence exists for the statement and/or what kind of evidence exists. An evidential is the particular grammatical element that indicates evidentiality...
support for each differential diagnosis
Differential diagnosis
A differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...
is presented, along with recommended follow-up that may be conducted by the clinician to arrive at a more definitive diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
. The system also serves as a clinician reference with a searchable database
Database
A database is an organized collection of data for one or more purposes, usually in digital form. The data are typically organized to model relevant aspects of reality , in a way that supports processes requiring this information...
of diseases and clinical manifestations.
History
Designed by the Laboratory of Computer Science at the Massachusetts General HospitalMassachusetts General Hospital
Massachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...
, work on DXplain began in 1984 with a first version being released in 1986 .
DXplain contains a database with crude probabilities for over 4,900 clinical manifestations that are associated with over 2,200 unique diseases, yielding a total of over 230,000 unique finding-disease interconnections .
Educational tool
Use of DXplain as a tool for medical consultation has been common to some institutions since it fills a gap, particularly for medical studentMedical Student
Medical Student may refer to:*Someone studying at medical school*Medical Student Newspaper, a UK publication...
s in clinical rotations, that is not adequately covered by textbook literature . The system's large knowledge base combined with its ability to formulate diagnostic hypotheses have made it a popular education tool for US-based medical schools; by 2005, DXplain was supporting more than 33,189 total users .
Methodology
DXplain generates ranked differential diagnoses using a pseudo-probabilistic algorithmAlgorithm
In mathematics and computer science, an algorithm is an effective method expressed as a finite list of well-defined instructions for calculating a function. Algorithms are used for calculation, data processing, and automated reasoning...
. Each clinical finding entered into DXplain is assessed by determining the importance of the finding and how strongly the finding supports a given diagnosis for each disease in the knowledge base
Knowledge base
A knowledge base is a special kind of database for knowledge management. A Knowledge Base provides a means for information to be collected, organised, shared, searched and utilised.-Types:...
. Using this criterion, DXplain generates ranked differential diagnoses with the most likely diseases yielding the lowest rank. Using stored information regarding each disease’s prevalence and significance, the system differentiates between common and rare diseases.
Accuracy
Analysis of accuracy has shown promise in DXplain and similar clinical decision support systems. In a preliminary trial investigation of 46 benchmark cases with a variety of diseases and clinical manifestations, the ranked differential diagnoses generated by DXplain were shown to be in alignment with a panel of five board-certified physicians . In another study investigating how well decision support systems work at responding to a bioterrorismBioterrorism
Bioterrorism is terrorism involving the intentional release or dissemination of biological agents. These agents are bacteria, viruses, or toxins, and may be in a naturally occurring or a human-modified form. For the use of this method in warfare, see biological warfare.-Definition:According to the...
event, an evaluation of 103 consecutive internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...
cases showed that Dxplain correctly identified the diagnosis in 73% of cases, with the correct diagnosis averaging a rank of 10.7 .