title: Evaluating a web-based clinical decision support system for language disorders screening in a nursery school.
abstract: BACKGROUND
  Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder.
  
  
  OBJECTIVE
  This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care.
  
  
  METHODS
  This paper details the evaluation results of the "Gades" CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child's language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results.
  
  
  RESULTS
  The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development.
  
  
  CONCLUSIONS
  This research demonstrated the benefit of a Web-based CDSS to monitor children's neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.
authors.affiliation: Technical University of Madrid, Department of Telematic and Electronic Engineering, Madrid, Spain. marialuisa.martinr@upm.es.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Martín Ruiz
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Valero Duboy
authors.forename: Carmen
authors.initials: C
authors.lastname: Torcal Loriente
authors.forename: Iván
authors.initials: I
authors.lastname: Pau de la Cruz
mesh_terms: D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D020407:Internet; D007806:Language Disorders / Q000175:diagnosis*; D008297:Male; D010372:Pediatrics; D011320:Primary Health Care; D015203:Reproducibility of Results; D012578:Schools, Nursery
keywords: eHealth; early diagnosis; evaluation; health information systems; knowledge management; language disorders; primary health care