Development of a novel mobile application to assist in the diagnosis of Fetal Alcohol Syndrome (FAS)

开发新型移动应用程序以协助诊断胎儿酒精综合症（FAS）

• 批准号: 9905934
• 负责人: Ganz Chockalingam
• 金额: $ 22.5万
• 依托单位: BLUE RESONANCE, LLC
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9905934
• 关键词: 3-Dimensional; Affect; Agreement; Automobile Driving; Back; Cellular Phone; Characteristics; Charge; Child; Clinical; Confidence Intervals; Confusion; Consensus; Consultations; Data; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Elements; Equation; Ethnic group; Evaluation; Expert Opinion; Face; Feedback; Fetal Alcohol Exposure; Fetal Alcohol Spectrum Disorder; Fetal Alcohol Syndrome; Fissural; Health Personnel; Health Professional; Image; Individual; Length; Licensing; Lip structure; Manuals; Measurement; Measures; Methodology; Mobile Health Application; Patients; Performance; Phenotype; Physicians; Population; Positioning Attribute; Process; Public Health; Race; Reporting; Sampling; Secure; Series; Services; Sex Differences; Shapes; Side; Structure; Surveys; Tablets; Technical Expertise; Technology; Testing; Thinness; Three-Dimensional Image; Validation; Validity and Reliability; animation; base; clinical Diagnosis; clinically relevant; cloud based; commercialization; cost; experience; falls; fetal diagnosis; heuristics; imaging modality; mobile application; novel; pediatrician; prototype; skills; tool

Project Summary/Abstract. Fetal alcohol spectrum disorder (FASD) is a major public health issue resulting from prenatal alcohol exposure (PAE), impacting between 1-5% of the US population and perhaps more than 630,000 children globally each year. When assessing for FASD the following facial features must to be evaluated as part of the diagnostic process: palpebral fissure length (PFL), thinness of the upper vermillion, and the smoothness of the philtrum. PFL is typically assessed with a metric ruler or photometrically, while the lip and philtrum are evaluated against a series of five Likert scale photos. Each of these assessments has methodological problems often resulting in unreliable application of specific diagnostic criteria. There is also a reluctance on the part of health care providers to diagnose FASD because they don’t feel confident in their skills, resulting in under- or misdiagnosis. Furthermore, the number of affected individuals is far greater than the capacity of diagnosticians, especially when considering the global impact of PAE. Some of the issues involved in the diagnosis of FASD could be remedied by simple-to-use mobile apps that would take much of the guesswork or heuristic elements out of the diagnostic equation, provide evaluation based upon expert opinion, and can be used by health care providers globally. Several aims of this project revolve around replacing the standard Likert scale lip-philtrum guide with an animation, morphing from a full to a thin upper lip on a continuous slider scale that the user controls while examining a subject. A similar morphing tool is proposed for the assessment of the philtrum. This would eliminate much of the confusion that exists between the rankings required for a fetal alcohol syndrome (FAS) or partial FAS (pFAS) diagnosis. The 5-point Likert scale doesn’t provide enough guidance and agreement even among experts is often mediocre. Rather than having a scale with only five demarcations, where really only the demarcation between a Rank 3 and 4 matters for a diagnosis, the apps allow for a more accurate assessment by providing a continuous distribution removing all ambiguity. Dysmorphologists who are expert at diagnosing FAS will determine the demarcation points for an upper lip and a smooth philtrum compatible with a diagnosis of FAS or pFAS for use in the app. Bias in the current diagnostic methods will also be assessed. PFL is an extremely difficult measurement even for experts, and it is proposed that using a smartphone camera with 3D capability would provide a more accurate way to assess this cardinal feature. These apps could be used by health care providers anywhere in the world to receive expert opinion feedback almost instantly to assist them in making a difficult yet critically important clinical diagnosis. We are in a unique position to accomplish these endeavors, as we have both the clinical and technical expertise to develop the apps, and access to data to validate the findings. Given the scope of the problem and the lack of access to expert diagnosticians, these mobile health applications should overcome at least some of the issues involved in the diagnosis of FASD.

项目概要/摘要。胎儿酒精谱系障碍（FASD）是一个主要的公共卫生问题， 产前酒精暴露（PAE），影响1-5%的美国人口，也许超过 全球每年有63万儿童。当评估FASD时，必须评估以下面部特征 作为诊断过程的一部分：睑裂长度（PFL），上朱砂的薄度， 人中的光滑PFL通常用米尺或光度法评估，而嘴唇和 对人中的五个李克特尺度的照片系列进行评估。这些评估中的每一项都有 方法上的问题往往导致具体诊断标准的应用不可靠。还有一个 医疗保健提供者不愿意诊断FASD，因为他们对自己的技能没有信心， 导致诊断不足或误诊。此外，受影响的人数远远超过 诊断人员的能力，特别是在考虑到PAE的全球影响时。涉及的一些问题 可以通过简单易用的移动的应用程序来弥补， 从诊断方程中排除猜测或启发性元素，根据专家意见提供评价， 并且可以被全球的卫生保健提供者使用。该项目的几个目标围绕着取代 标准李克特规模唇人中指南与动画，从一个完整的变形到一个薄上唇上连续 用户在检查受试者时控制的滑块比例。提出了一个类似的变形工具， 对人中的评估。这将消除所需排名之间存在的大部分混淆 胎儿酒精综合征（FAS）或部分FAS（pFAS）诊断。李克特五点量表并没有提供 即使在专家之间，足够的指导和一致意见也往往是平庸的。而不是只有一个尺度 五个分界线，其中只有等级3和4之间的分界线对诊断很重要，应用程序 通过提供去除所有模糊性的连续分布来允许更准确的评估。 擅长诊断FAS的畸形学家将确定上唇的分界点， 与FAS或pFAS诊断兼容的平滑人中，用于应用程序。 还将评估方法。PFL是一个非常困难的测量，即使是专家，它是建议 使用具有3D功能的智能手机摄像头将提供一种更准确的方法来评估这种红衣主教 功能.世界任何地方的医疗保健提供者都可以使用这些应用程序来获取专家意见 反馈几乎立即帮助他们作出困难但至关重要的临床诊断。我们在 一个独特的地位，以完成这些努力，因为我们有两个临床和技术专长，以发展 应用程序，并访问数据以验证调查结果。鉴于这一问题的范围和缺乏获得 专家诊断，这些移动的健康应用程序应该克服至少一些问题， FASD的诊断