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

Project Summary AbstractFetal alcohol spectrum disorderFASDis a major public health issue resulting from prenatal alcohol exposurePAEimpacting betweenof the US population and perhaps more thanchildren globally each yearWhen assessing for FASD the following facial features must to be evaluated as part of the diagnostic processpalpebral fissure lengthPFLthinness of the upper vermillionand the smoothness of the philtrumPFL is typically assessed with a metric ruler or photometricallywhile the lip and philtrum are evaluated against a series of five Likert scale photosEach of these assessments has methodological problems often resulting in unreliable application of specific diagnostic criteriaThere is also a reluctance on the part of health care providers to diagnose FASD because they don t feel confident in their skillsresulting in underor misdiagnosisFurthermorethe number of affected individuals is far greater than the capacity of diagnosticiansespecially when considering the global impact of PAESome 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 equationprovide evaluation based upon expert opinionand can be used by health care providers globallySeveral aims of this project revolve around replacing the standard Likert scale lip philtrum guide with an animationmorphing from a full to a thin upper lip on a continuous slider scale that the user controls while examining a subjectA similar morphing tool is proposed for the assessment of the philtrumThis would eliminate much of the confusion that exists between the rankings required for a fetal alcohol syndromeFASor partial FASpFASdiagnosisThepoint Likert scale doesn t provide enough guidance and agreement even among experts is often mediocreRather than having a scale with only five demarcationswhere really only the demarcation between a Rankandmatters for a diagnosisthe apps allow for a more accurate assessment by providing a continuous distribution removing all ambiguityDysmorphologists 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 appBias in the current diagnostic methods will also be assessedPFL is an extremely difficult measurement even for expertsand it is proposed that using a smartphone camera withD capability would provide a more accurate way to assess this cardinal featureThese 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 diagnosisWe are in a unique position to accomplish these endeavorsas we have both the clinical and technical expertise to develop the appsand access to data to validate the findingsGiven the scope of the problem and the lack of access to expert diagnosticiansthese mobile health applications should overcome at least some of the issues involved in the diagnosis of FASD Project Narrative Fetal alcohol spectrum disorderFASDis a major global public health issue and certain diagnosis under this umbrella term require the assessment of specific facial featuresCurrentlythe tools available to measure these cardinal facial features are subjective and not reliablewhich may contribute to the fact that health professionals are often reluctant to make an FASD diagnosisWe are developing simple to usesmartphone tablet based apps to accurately and reliably evaluate these cardinal facial features