title: Combining geometric and probabilistic reasoning for computer-based penetrating-trauma assessment.
abstract: OBJECTIVE
  To ascertain whether three-dimensional geometric and probabilistic reasoning methods can be successfully combined for computer-based assessment of conditions arising from ballistic penetrating trauma to the chest and abdomen.
  
  
  METHODS
  The authors created a computer system (TraumaSCAN) that integrates three-dimensional geometric reasoning about anatomic likelihood of injury with probabilistic reasoning about injury consequences using Bayesian networks. Preliminary evaluation of TraumaSCAN was performed via a retrospective study testing performance of the system on data from 26 cases of actual gunshot wounds.
  
  
  METHODS
  Areas under the receiver operating characteristics (ROC) curve were calculated for each condition modeled in TraumaSCAN that was present in the 26 cases. The comprehensiveness and relevance of the TraumaSCAN diagnosis for the 26 cases were used to assess the overall performance of the system. To test the ability of TraumaSCAN to handle limited findings, these measurements were calculated both with and without input of observed findings into the Bayesian network.
  
  
  RESULTS
  For the 11 conditions assessed, the worst area under the ROC curve with no observed findings input into the Bayesian network was 0.542 (95% CI, 0.146-0.937), the median was 0.883 (95% CI, 0.713-1.000), and the best was 1.00 (95% CI, 1.000-1.000). The worst area under the ROC curve with all observed findings input into the Bayesian network was 0.835 (95% CI, 0.602-1.000), the median was 0.941 (95% CI, 0.827-1.000), and the best was 0.992 (95% CI, 0.965-1.000). A comparison of the areas under the curve obtained with and without input of observed findings into the Bayesian network showed that there were significant differences for 2 of the 11 conditions assessed.
  
  
  CONCLUSIONS
  A computer-based method that combines geometric and probabilistic reasoning shows promise as a tool for assessing ballistic penetrating trauma to the chest and abdomen.
authors.affiliation: Decision System Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. ogunyemi@dsg.harvard.edu
authors.forename: Omolola I
authors.initials: OI
authors.lastname: Ogunyemi
authors.forename: John R
authors.initials: JR
authors.lastname: Clarke
authors.forename: Nachman
authors.initials: N
authors.lastname: Ash
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Webber
mesh_terms: D001499:Bayes Theorem; D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008432:Mathematical Computing; D008953:Models, Anatomic; D016571:Neural Networks, Computer; D011336:Probability; D012372:ROC Curve; D012189:Retrospective Studies; D014584:User-Computer Interface; D014948:Wounds, Gunshot / Q000175:diagnosis*