Download Case Study for Lower Urinary Tract Symptom Management

Case Study for Lower Urinary Tract Symptom Management
Version 1.0
Authors: John R, Jackson B, Sanders P, Chilton C P, Henley M J.
Dept. of Urology, Derby Hospitals Foundation Trust
LUTS CASE STUDY
Can a Computer Manage 400 men with LUTS without making a mistake?
Introduction
Management of LUTS is a significant part of the urological workload. We set out to
develop a computer expert system, designed to provide safe and appropriate advice
which could be directly communicated to a patient’s GP. The computer system
developed is internet based and data base driven. It manages LUTS with knowledge of
the patient’s previous treatments and results. The database algorithm is based on the
guidelines issued by BAUS and EAU interpreting indices such as IPSS, bother score,
flow-rate etc. as well as presence of haematuria, age-related PSA, effect of medications
on PSA amongst other factors. The computer generates a letter to the GP which
summarises the information gained and advises on further relevant examination or tests,
clinical management and follow up. The system could be used in the set up of a nurse
lead out-reach assessment service.
Method
We initially conducted a trial of the software on 49 dummy patients to ensure that the
computer system provided satisfactory advice. Subsequently a prospective trial of the
software was conducted on 81 patients attending the Prostate Assessment Clinic. Errors
were noted in 9 patients; the system failing to prescribe medications in 8 patients with
severe symptoms and failing to highlight a high creatinine level in 1 patient. The software
was then subjected to a de-bugging process and a subsequent retrospective study
conducted on a total of 385 patients.
Computer analysis was assessed for errors and adherence to the LUTS guidelines by
the authors.
Results
The main clinical features on the studied population (n = 385) were as follows:
Mean age:
Mean IPSS and bother scores:
Blood on dipstick:
Mean Qmax:
Flow rate:
Mean voided volume:
Mean post micturition residual:
Mean creatinine level:
Mean PSA:
69.5 years (range of 42 - 95).
16 and 3.8 respectively.
29 patients
13.1
< 10 in 190 patients
10 -15 in 50 patients
> 15 in 108 patients
not determined in 37 patients.
243 mls
118mls (maximum of 1000ml).
100.6 (range of 56 - 693).
2.75 (range of 38.2 - 0.09).
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LUTS CASE STUDY
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LUTS CASE STUDY
The guidelines were clearly adhered to in all patients with regards to management such
as prescribing alpha-blockers or 5-alpha reductase inhibitors; or monitoring bladder
residuals and serum creatinine.
With regards to referral of patients, the computer again adhered to the guidelines in all
patients. Risk factors such as high PSA levels in 37 patients(including suspicious PSA
levels in patients on 5-alpha recuctase inhibitors), high creatinine levels in 24 patients,
high post micturition bladder residuals in 44 patients, presence of dip stick haematuria in
29 patients and presence of severe symptoms in 93 patients were flagged up by the
system and the appropriate referral made.
In total, 161 patients were referred and the remaining 224 managed in the community.
Conclusion
The software system has been shown to be an effective and reliable tool in safely
managing patients with lower urinary tract symptoms and making appropriate referrals to
Urology Consultant Services when required.
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LUTS CASE STUDY
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