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Cluster Headache Help and Support >> Cluster Headache Specific >> Computer Based Diagnostic Test--update
(Message started by: Bob_Johnson on May 4th, 2008, 11:11am)

Title: Computer Based Diagnostic Test--update
Post by Bob_Johnson on May 4th, 2008, 11:11am
Good looking update! If it gains acceptance, we will have a tool to reduce the impact of physicians with limited knowledge & experience. The dream would be that DJ might license the test and post it in it's own neat little box!

(But development to the point of commercial use may be a couple of years off.)
==================

An expert system for headache diagnosis: the Computerized Headache Assessment tool (CHAT).

Maizels M, Wolfe WJ.

Kaiser Permanente--Family Medicine, Woodland Hills, CA 91365-4084, USA.

BACKGROUND: Migraine is a highly prevalent chronic disorder associated with significant morbidity. Chronic daily headache syndromes, while less common, are less likely to be recognized, and impair quality of life to an even greater extent than episodic migraine. A variety of screening and diagnostic tools for migraine have been proposed and studied. Few investigators have developed and evaluated computerized programs to diagnose headache. OBJECTIVES: To develop and determine the accuracy and utility of a computerized headache assessment tool (CHAT). CHAT was designed to identify all of the major primary headache disorders, distinguish daily from episodic types, and recognize medication overuse. METHODS: CHAT was developed using an expert systems approach to headache diagnosis, with initial branch points determined by headache frequency and duration. Appropriate clinical criteria are presented relevant to brief and longer-lasting headaches. CHAT was posted on a web site using Microsoft active server pages and a SQL-server database server. A convenience sample of patients who presented to the adult urgent care department with headache, and patients in a family practice waiting room, were solicited to participate. Those who completed the on-line questionnaire were contacted for a diagnostic interview. RESULTS: One hundred thirty-five patients completed CHAT and 117 completed a diagnostic interview. CHAT correctly identified 35/35 (100%) patients with episodic migraine and 42/49 (85.7%) of patients with transformed migraine. CHAT also correctly identified 11/11 patients with chronic tension-type headache, 2/2 with episodic tension-type headache, and 1/1 with episodic cluster headache. Medication overuse was correctly recognized in 43/52 (82.7%). The most common misdiagnoses by CHAT were seen in patients with transformed migraine or new daily persistent headache. Fifty patients were referred to their primary care physician and 62 to the headache clinic. Of 29 patients referred to the PCP with a confirmed diagnosis of migraine, 25 made a follow-up appointment, the PCP diagnosed migraine in 19, and initiated migraine-specific therapy or prophylaxis in 17. CONCLUSION: THE DESCRIBED EXPERT SYSTEM DISPLAYS HIGH DIAGNOSTIC ACCURACY FOR MIGRAINE AND OTHER PRIMARY HEADACHE DISORDERS, INCLUDING DAILY HEADACHE SYNDROMES AND MEDICATION OVERUSE. AS PART OF A DISEASE MANAGEMENT PROGRAM, CHAT LED TO PATIENTS RECEIVING APPROPRIATE DIAGNOSES AND THERAPY. LIMITATIONS OF THE SYSTEM INCLUDE PATIENT WILLINGNESS TO UTILIZE THE PROGRAM, INTRODUCING SUCH A PROCESS INTO THE CULTURE OF MEDICAL CARE, AND THE DIFFICULT DISTINCTION OF TRANSFORMED MIGRAINE.

PMID: 17868352 [PubMed]

Title: Re: Computer Based Diagnostic Test--update
Post by Kevin_M on May 4th, 2008, 11:23am
CHAT. Is this what was revealed and discussed in infancy at the 2004 Nashville convention by a former OUCH pres, and also more recently at a Clusterbuster convention, or was that CHATS?


Title: Re: Computer Based Diagnostic Test--update
Post by Gator on May 5th, 2008, 12:29am
That was CHATS - an online cluster headache tracking system.

Wow.  That's cool.  I can see all the major headache organizations wanting it on their websites.  It'll be interesting to see if this CHAT program gains acceptance by the medical community, though.  Something to watch for.

In the meantime, since it's been brought up...What's up with CHATS these days?



Title: Re: Computer Based Diagnostic Test--update
Post by Linda_Howell on May 5th, 2008, 1:40am

That you Bob J... :-*


Quote:
In the meantime, since it's been brought up...What's up with CHATS these days?


 Yes I'd like to know the answer to that also.




Title: Re: Computer Based Diagnostic Test--update
Post by Kevin_M on May 5th, 2008, 1:59am

on 05/05/08 at 00:29:45, Gator wrote:
That was CHATS - an online cluster headache tracking system.


Thanks, Mike. That's how I remembered it when I talked with him after the presentation. I saw he was at CB convention.
Funny how the names are similar.




Quote:
Those who completed the on-line questionnaire were contacted for a diagnostic interview.

CHAT correctly identified... 1/1 with episodic cluster headache.


Trials expanded for clusters and available could be helpful for diagnosis.


One of the limitations mentions:


Quote:
INTRODUCING SUCH A PROCESS INTO THE CULTURE OF MEDICAL CARE


The pro and con controversy of that might be interesting. :)      But with a good track record, acceptance might seem anticipated.




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