TraumAID Background

Brief Description of TraumAID

TraumAID is a program to assist physicians during the critical period after the patient comes into the hospital and has been stabilized (the time referred to as `the initial definitive management'). In such an emergency situation, it is important to assess when it is appropriate to diagnose, and when it is appropriate to treat the injuries. Often, a physician must initiate therapy (abbreviated `Rx') before completely diagnosing the extent of the injuries. Sometimes, therapeutic actions can also help diagnose the patient's condition. From the known information, TraumAID proposes goals to address, such as a goal for diagnosing a particular condition or a goal for treating an injury. From these goals, TraumAID produces a plan (consisting of actions) that address the goals as best as possible, based on costs, time, location (some actions can only take place in certain areas, such as in the Operating Room), and other factors.

In the development version of TraumAID, the program guides the user explicitly, or takes an active role in pursuing the diagnosis and treatment. For example, when the user enters the clinical findings and lets the program guide, the program may solicit more information or may decide it has enough information to act, in which case it suggests an action (the topmost from the plan). In general, bedside questions are asked first, and then the steps of the plan are executed. It is important to note that the program does not compile a complete plan for diagnosis and treatment, then simply execute it. The program suggests a plan that addresses all the currently known goals, but as actions are done, more information becomes available which might change the plan.

One of the most important aspects of TraumAID is its ability to change the plan to incorporate more information when it becomes available. The central philosophy behind this is that sometimes it is more important to act than it is to gather more information. TraumAID decides whether it is more worthwhile at the moment to pursue information gathering or perform treatment. In contrast, the TraumAID installed in the Emergency Room takes a passive role. This means that it does not ask a question or tell the doctor what to do, rather it accepts the actions that the doctors have performed, and displays the plan to the physicians.

Brief History

The TraumAID project began around 1984 with TraumAID 1.0. The original version was developed on a Symbolics machine, in the Genera dialect of Lisp. TraumAID's domain of expertise was limited to the abdomen. Over the next few years, Dr. Clarke, Bonnie Webber, and Michael Niv worked to expand the domain to the chest and abdomen. Strictly speaking, TraumAID 1.0 was a production system, or expert system, that consisted of a rulebase that mapped findings to conclusions and prescriptions (actions to be done). After a few years, it was recognized that the system might perform better if the task were divided between a goal-directed diagnosic reasoner, and a companion planner. The diagnostic reasoner will use evidence to characterize the patient's state, and to propose diagnostic and therapeutic goals. The planner would consider alternative means for each goal, and propose a management plan. To close the loop, actions taken by the physician will provide new evidence thereby trigerring a new cycle of diagnostic reasoning and planning. TraumAID 2.0, a new system implementing the above ideas, was judged to outperform its predecessor on a collection of real trauma cases by a ratio of 62:9, with 26 ties. Furthermore, the judges found its management plans preferable to actual care, by a ratio of 64:17, with 16 ties. For more information on TraumAID 2.0, see Ron Rymon's thesis. Since the goal was to have the system operational in an emergency room, the project took on another direction in the late eighties with the development of the HyperCard interface to TraumAID, also known as the clinical interface to the program.

The HyperCard interface was designed to be used at a nurse's or technician's station, where a person would enter information on one card and relevant information would be displayed on an external monitor, next to or above the patient's bed. The interface would combine recording the case for hospital records and passing the information to TraumAID, where the program would respond with its advice. The interface was originally designed and implemented as senior undergraduate projects.

TraumAID 1.0 and 2.0 were developed on a Symbolics machine. TraumAID was linked with HyperCard using Symbolics' MacIvory board, which essentially puts a Symbolics machine inside a Macintosh. The original TraumAID 1.0 was also ported to C, and shown to execute on a laptop, for demonstration purposes. Unfortunately, the Symbolics machines did not stand the test of time, as other machines became faster and much cheaper. It was clear that program development needed to be moved to a more general platform.

In 1991, TraumAID was ported to the X-windows environment, under Lucid Common Lisp with a Tcl/Tk front end), and later to the Macintosh, under Macintosh Common Lisp. TraumAID communicates with HyperCard using Apple Events, a System 7 feature that enables interprocess communication.

When we talk about TraumAID as a whole (the project), we talk about two different types of interfaces for TraumAID, the development interface and the clinical interface. Quite naturally, we use the development interface to develop the TraumAID reasoner and planner. The development interface is executable in X-windows, on the Mac, and through a simple text interface. The text interface would be useful if you were forced to run TraumAID from a VT100, or similar non-X-based platform.

For some technical information about the system, you may be interested in the TraumAID 2.0 Technical Document, which is a sketch of the major components of TraumAID as seen through various notes collected over the years.

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