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Online tool to aid diagnosis

By Julie Clothier for CNN

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The Web site Isabel prompts doctors to think of alternative diagnoses
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LONDON, England (CNN) -- Looking at her now, it is hard to believe Isabel Maude nearly died five years ago after doctors failed to diagnose a potentially fatal illness.

Apart from a few scars, the nine-year-old is fit and healthy and there is nothing to indicate she spent weeks in a London hospital as a toddler.

Now, her parents want the name Isabel, the title of an Internet-based tool they have designed for doctors to make diagnosis easier, to become an important tool for medical staff, and as ubiquitous in the profession as a stethoscope.

In April 1999, Isabel, then three and a half, developed chicken pox.

Two days later she became very ill but repeated visits to doctors and hospital emergency departments over the next three days did not uncover a diagnosis.

Ten minutes after the last visit, Isabel collapsed and was eventually diagnosed with necrotizing fasciitis, a potentially fatal "flesh-eating" disease.

She spent three weeks in intensive care and four weeks in a high-dependency unit and, says her father Jason Maude, nearly died.

Maude says and he and his wife, Charlotte, searched for answers during the time Isabel spent in hospital as to why this had happened and decided to create something positive out of the experience.

"That delay in diagnosis could have cost her her life -- and very nearly did. This is something, had it been diagnosed a couple of days earlier, that could have been fixed with a course of penicillin," he says.

In 2000, the couple set up Isabel Medical Charity, and after working with a group of medical experts, created an online diagnosis system, specifically for pediatric doctors who have doubts about the symptoms a patient presents.

"When you're unwell, you are first assessed with people who are the least prepared to do so. They often have to refer upwards to doctors who have more knowledge, and that's often not possible because of lack of availability."

The site, which is only for medically trained staff and is not available to the general public, asks the doctor to describe the symptoms.

"Often they are very basic, like rash, fever or diarrhea," Maude says.

It then brings up a list of 10 potential diagnoses, and information from medical journals and medical text books about those conditions.

"We are not saying this will give you a definitive diagnosis. It just prompts you to think about conditions that you otherwise may not have," he says.

"It's a bit like having a professor on your shoulder. Our research shows that 95 percent of the time, the accurate diagnosis is in the original list of 10."

The charity began offering the service for free but earlier this year, it made the site commercial, because it was no longer viable to offer a free service.

Maude believes the device has the potential to save hospitals billions in early diagnosis, preventing patients from having prolonged hospital stays.

"It's as easy to use as Google and virtually requires zero training and no assistance from IT departments to install it is needed."

Dr Mike Coren, consultant pediatric at St Mary's Hospital in London, helped test the site when it was first launched.

He says Isabel can trigger conditions that a doctor may not have thought of but doctors will always tend to trust their instinct first.

"It is not a natural instinct for a doctor to look something up on a computer. They are much more likely to check something with a colleague verbally."

Coren says Isabel has a better memory than humans and is a useful tool for cases that are difficult to diagnose.

"As the mind set of medical staff changes and they begin to use computer equipment more and more, and as Isabel develops, it will move forward with that."

An adult version of Isabel is being launched later this year. Four UK hospitals and one U.S. hospital currently subscribe to the pediatric service.


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