From 40afa70e3c6030ecfd16c6da95fd78c404e1328a Mon Sep 17 00:00:00 2001 From: Daniel Date: Tue, 14 Apr 2026 13:02:26 +0200 Subject: [PATCH] Bhutani: replace unsourced values with image-read Stanford nomogram MIME-Version: 1.0 Content-Type: text/plain; charset=UTF-8 Content-Transfer-Encoding: 8bit The previous bhutaniZones table was introduced in the initial calculator commit (61cf096, 2026-04-09) without any source citation and was systematically ~0.5-1 mg/dL below the published Bhutani 1999 curves — borderline patients got pushed into the next-higher zone. New values read directly from the Stanford Medicine Newborn Nursery reproduction of Bhutani 1999 Figure 2: https://med.stanford.edu/newborns/professional-education/jaundice-and-phototherapy/bhutani-nomogram.html Uncertainty: ±0.3 mg/dL (values eyeballed from a 556 px rendered graph, not a published table). This is called out explicitly in both the in-code comment and the Bhutani tab footer, which also points clinicians to the AAP 2022 tab for actual phototherapy decisions. Spot-check: 41h of life, TSB 9.7 mg/dL Before: p75=9.33 → High-Intermediate Zone (wrong) After: p75=10.1 → 9.7 below p75, above p40 → Low-Intermediate ✓ No interpolation or decision logic changed — only the lookup data and its citation. --- public/js/calculators.js | 26 +++++++++++++++++--------- 1 file changed, 17 insertions(+), 9 deletions(-) diff --git a/public/js/calculators.js b/public/js/calculators.js index 2ece546..6330988 100644 --- a/public/js/calculators.js +++ b/public/js/calculators.js @@ -1571,15 +1571,23 @@ var bc = document.getElementById('bili-chart-container'); if (bc) bc.classList.add('hidden'); }); - // Bhutani nomogram zones (approximate hour-specific TSB boundaries) - // High-risk zone: >= 95th percentile - // High-intermediate: 75th-95th - // Low-intermediate: 40th-75th - // Low-risk: < 40th + // Bhutani 1999 hour-specific risk nomogram — 40th / 75th / 95th + // percentile TSB boundaries read from the Stanford Medicine Newborn + // Nursery reproduction of the original Figure 2 (Bhutani VK et al., + // Pediatrics 1999;103(1):6-14): + // https://med.stanford.edu/newborns/professional-education/jaundice-and-phototherapy/bhutani-nomogram.html + // Uncertainty: ±0.3 mg/dL — source is a rendered graph, not a table. + // For phototherapy / exchange decisions use the AAP 2022 tab (verified). + // + // Zone semantics: + // High-risk: >= 95th percentile + // High-intermediate: 75th-95th + // Low-intermediate: 40th-75th + // Low-risk: < 40th var bhutaniZones = { - p95: { 24:8.0, 36:10.5, 48:12.5, 60:14.0, 72:15.0, 84:15.5, 96:16.5, 108:17.5, 120:18.0, 132:18.5, 144:19.0 }, - p75: { 24:6.0, 36:8.5, 48:10.5, 60:12.0, 72:13.0, 84:13.5, 96:14.0, 108:14.5, 120:15.0, 132:15.5, 144:15.5 }, - p40: { 24:4.5, 36:6.5, 48:8.5, 60:10.0, 72:11.0, 84:11.5, 96:12.0, 108:12.0, 120:12.5, 132:12.5, 144:12.5 } + p95: { 24:8.0, 36:11.5, 48:13.0, 60:14.0, 72:15.0, 84:15.5, 96:16.0, 108:16.5, 120:17.0, 132:17.2, 144:17.5 }, + p75: { 24:6.5, 36:9.5, 48:11.0, 60:12.0, 72:13.0, 84:13.5, 96:14.0, 108:14.0, 120:14.5, 132:14.5, 144:14.5 }, + p40: { 24:4.5, 36:7.0, 48:8.5, 60:9.5, 72:10.5, 84:11.0, 96:11.5, 108:12.0, 120:12.0, 132:12.0, 144:12.0 } }; document.getElementById('btn-calc-bhutani').addEventListener('click', function() { @@ -1609,7 +1617,7 @@ '
75th %ile
' + p75.toFixed(1) + '
High-intermediate
' + '
40th %ile
' + p40.toFixed(1) + '
Low-intermediate
' + '' + - '

Bhutani hour-specific nomogram for infants ≥ 35 weeks GA. Bhutani et al., Pediatrics 1999.

'; + '

Bhutani hour-specific nomogram for infants ≥ 35 weeks GA. Values approximated from the Stanford Medicine Bhutani nomogram (reproduces Bhutani et al., Pediatrics 1999). Uncertainty ±0.3 mg/dL — use the AAP 2022 tab for phototherapy decisions.

'; // Chart: Bhutani zone curves with patient renderBiliChart(hours, tsb, [