docuneo:criteri_di_bell_s_modificati [DocuNeo]

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</style>

<div class="bell-calculator">
    <h1 class="bell-title">📊 Criteri di Bell Modificati</h1>
    <div class="bell-subtitle">Griglia di Valutazione per Stadiazione NEC</div>
    
    <!-- Informazioni sulla Valutazione -->
    <div class="evaluation-info">
        <h3>🎯 Sistema di Valutazione</h3>
        <div class="info-text">
            Seleziona tutti i segni/sintomi presenti nel paziente.<br>
            Il sistema determinerà automaticamente lo stadio NEC più alto soddisfatto dai criteri.
        </div>
    </div>

    <!-- Segni Sistemici -->
    <div class="criteria-group">
        <div class="group-header">
            <span>🌡️ Segni Sistemici</span>
            <span class="group-status" id="systemic-status">0 criteri</span>
        </div>
        <div class="group-content">
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'temperature')">
                <span class="criterion-text">Instabilità della temperatura</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'apnea')">
                <span class="criterion-text">Apnea, bradicardia</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'lethargy')">
                <span class="criterion-text">Letargia</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'acidosis')">
                <span class="criterion-text">Acidosi metabolica (lieve)</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'thrombocytopenia')">
                <span class="criterion-text">Trombocitopenia (lieve)</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'hypotension')">
                <span class="criterion-text">Ipotensione</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'severe-apnea')">
                <span class="criterion-text">Bradicardia, apnea severa</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'combined-acidosis')">
                <span class="criterion-text">Acidosi respiratoria e metabolica combinata</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'dic')">
                <span class="criterion-text">Coagulazione intravascolare disseminata</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'systemic', 'neutropenia')">
                <span class="criterion-text">Neutropenia</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
        </div>
    </div>

    <!-- Segni Intestinali -->
    <div class="criteria-group">
        <div class="group-header">
            <span>🤱 Segni Intestinali</span>
            <span class="group-status" id="intestinal-status">0 criteri</span>
        </div>
        <div class="group-content">
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'residuals')">
                <span class="criterion-text">Elevati residui pre-gavage</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'distension')">
                <span class="criterion-text">Lieve distensione addominale</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'vomiting')">
                <span class="criterion-text">Vomito</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'guaiac-positive')">
                <span class="criterion-text">Guaiac-positivo delle feci</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'bloody-stool')">
                <span class="criterion-text">Sangue evidente nelle feci</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'absent-sounds')">
                <span class="criterion-text">Assenti rumori intestinali</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'tenderness')">
                <span class="criterion-text">Dolorabilità addominale</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'definite-tenderness')">
                <span class="criterion-text">Dolorabilità addominale definita</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'cellulitis')">
                <span class="criterion-text">Cellulite addominale o massa quadrante destro</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'peritonitis')">
                <span class="criterion-text">Segni di peritonite</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'intestinal', 'marked-distension')">
                <span class="criterion-text">Dolorabilità marcata e distensione dell'addome</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
        </div>
    </div>

    <!-- Segni Radiologici -->
    <div class="criteria-group">
        <div class="group-header">
            <span>📻 Segni Radiologici</span>
            <span class="group-status" id="radiological-status">0 criteri</span>
        </div>
        <div class="group-content">
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'normal')">
                <span class="criterion-text">Normale o dilatazione intestinale</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'mild-ileus')">
                <span class="criterion-text">Ileo lieve</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'intestinal-dilation')">
                <span class="criterion-text">Dilatazione dell'ansa intestinale, ileo</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'pneumatosis')">
                <span class="criterion-text">Pneumatosis intestinalis</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'portal-gas')">
                <span class="criterion-text">Gas portale</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'portal-vein-gas')">
                <span class="criterion-text">Veno gas portale</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'ascites')">
                <span class="criterion-text">Ascite</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'definite-ascites')">
                <span class="criterion-text">Ascite definita</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
            <div class="criterion-item" onclick="toggleCriterion(this, 'radiological', 'pneumoperitoneum')">
                <span class="criterion-text">Pneumoperitoneo</span>
                <span class="criterion-status">PRESENTE</span>
            </div>
        </div>
    </div>

    <!-- Sezione Risultati -->
    <div class="results-section">
        <h3 style="text-align: center; margin-top: 0; color: #1976d2;">📊 Valutazione Stadiazione NEC</h3>
        
        <!-- Riassunto Gruppi Criteri -->
        <div class="criteria-summary">
            <div class="summary-item not-satisfied" id="systemic-summary">
                <div>🌡️ Segni Sistemici</div>
                <div id="systemic-count">0 presenti</div>
            </div>
            <div class="summary-item not-satisfied" id="intestinal-summary">
                <div>🤱 Segni Intestinali</div>
                <div id="intestinal-count">0 presenti</div>
            </div>
            <div class="summary-item not-satisfied" id="radiological-summary">
                <div>📻 Segni Radiologici</div>
                <div id="radiological-count">0 presenti</div>
            </div>
        </div>

        <!-- Valutazione Stadi -->
        <div class="stages-evaluation">
            <h4 style="text-align: center; color: #1976d2;">📋 Verifica Criteri per Stadio</h4>
            
            <div class="stage-check not-met" id="stage-ia-check">
                <span>Stadio IA - NEC Sospetta</span>
                <span class="stage-status status-not-met">NON SODDISFATTO</span>
            </div>
            
            <div class="stage-check not-met" id="stage-ib-check">
                <span>Stadio IB - NEC Sospetta</span>
                <span class="stage-status status-not-met">NON SODDISFATTO</span>
            </div>
            
            <div class="stage-check not-met" id="stage-iia-check">
                <span>Stadio IIA - NEC Definitiva Lieve</span>
                <span class="stage-status status-not-met">NON SODDISFATTO</span>
            </div>
            
            <div class="stage-check not-met" id="stage-iib-check">
                <span>Stadio IIB - NEC Definitiva Moderata</span>
                <span class="stage-status status-not-met">NON SODDISFATTO</span>
            </div>
            
            <div class="stage-check not-met" id="stage-iiia-check">
                <span>Stadio IIIA - NEC Severa, Intestino Intatto</span>
                <span class="stage-status status-not-met">NON SODDISFATTO</span>
            </div>
            
            <div class="stage-check not-met" id="stage-iiib-check">
                <span>Stadio IIIB - NEC Severa, Intestino Perforato</span>
                <span class="stage-status status-not-met">NON SODDISFATTO</span>
            </div>
        </div>
        
        <!-- Diagnosi Finale -->
        <div id="final-diagnosis" class="final-diagnosis diagnosis-none">
            🔍 DIAGNOSI: Seleziona i segni presenti per determinare lo stadio NEC
        </div>
        
        <div class="action-buttons">
            <button class="action-btn reset-btn" onclick="resetCalculator()">🔄 Reset</button>
            <button class="action-btn print-btn" onclick="printResults()">🖨️ Stampa</button>
        </div>
    </div>
</div>

<script>
var selectedCriteria = {
    systemic: {},
    intestinal: {},
    radiological: {}
};

function toggleCriterion(element, category, criterionId) {
    if (selectedCriteria[category][criterionId]) {
        delete selectedCriteria[category][criterionId];
        element.classList.remove('selected');
    } else {
        selectedCriteria[category][criterionId] = true;
        element.classList.add('selected');
    }
    
    updateGroupStatus(category);
    evaluateStages();
}

function updateGroupStatus(category) {
    var count = Object.keys(selectedCriteria[category]).length;
    var statusElement = document.getElementById(category + '-status');
    var summaryElement = document.getElementById(category + '-summary');
    var countElement = document.getElementById(category + '-count');
    
    statusElement.textContent = count + ' criteri';
    countElement.textContent = count + ' presenti';
    
    if (count > 0) {
        statusElement.classList.add('satisfied');
        summaryElement.className = 'summary-item satisfied';
    } else {
        statusElement.classList.remove('satisfied');
        summaryElement.className = 'summary-item not-satisfied';
    }
}

function evaluateStages() {
    var stages = {
        'ia': checkStageIA(),
        'ib': checkStageIB(),
        'iia': checkStageIIA(),
        'iib': checkStageIIB(),
        'iiia': checkStageIIIA(),
        'iiib': checkStageIIIB()
    };
    
    // Aggiorna display per ogni stadio
    for (var stage in stages) {
        updateStageDisplay(stage, stages[stage]);
    }
    
    // Determina lo stadio più alto soddisfatto
    var highestStage = getHighestSatisfiedStage(stages);
    updateFinalDiagnosis(highestStage);
}

function checkStageIA() {
    // Richiede: almeno UN segno sistemico base O almeno UN segno intestinale base O almeno UN RX normale/lieve
    var systemicBase = selectedCriteria.systemic.temperature || 
                      selectedCriteria.systemic.apnea || 
                      selectedCriteria.systemic.lethargy;
    
    var intestinalBase = selectedCriteria.intestinal.residuals || 
                        selectedCriteria.intestinal.distension || 
                        selectedCriteria.intestinal.vomiting || 
                        selectedCriteria.intestinal['guaiac-positive'];
    
    var radiologicalBase = selectedCriteria.radiological.normal || 
                          selectedCriteria.radiological['mild-ileus'];
    
    return systemicBase || intestinalBase || radiologicalBase;
}

function checkStageIB() {
    // Come IA O sangue evidente nelle feci
    return checkStageIA() || selectedCriteria.intestinal['bloody-stool'];
}

function checkStageIIA() {
    // Come IA O assenza rumori intestinali O pneumatosis
    var baseIA = checkStageIA();
    var absentSounds = selectedCriteria.intestinal['absent-sounds'];
    var pneumatosis = selectedCriteria.radiological.pneumatosis;
    
    return baseIA || absentSounds || pneumatosis;
}

function checkStageIIB() {
    // Come IIA O acidosi/trombocitopenia O gas portale O dolorabilità definita
    var baseIIA = checkStageIIA();
    var systemicProgression = selectedCriteria.systemic.acidosis || 
                             selectedCriteria.systemic.thrombocytopenia;
    var portalGas = selectedCriteria.radiological['portal-gas'] || 
                   selectedCriteria.radiological['portal-vein-gas'];
    var definiteTenderness = selectedCriteria.intestinal['definite-tenderness'];
    
    return baseIIA || systemicProgression || portalGas || definiteTenderness;
}

function checkStageIIIA() {
    // Come IIB O segni sistemici severi O peritonite O ascite definita
    var baseIIB = checkStageIIB();
    var severeSystolic = selectedCriteria.systemic.hypotension || 
                        selectedCriteria.systemic['severe-apnea'] || 
                        selectedCriteria.systemic['combined-acidosis'] || 
                        selectedCriteria.systemic.dic || 
                        selectedCriteria.systemic.neutropenia;
    var peritonitis = selectedCriteria.intestinal.peritonitis || 
                     selectedCriteria.intestinal['marked-distension'];
    var definiteAscites = selectedCriteria.radiological['definite-ascites'];
    
    return baseIIB || severeSystolic || peritonitis || definiteAscites;
}

function checkStageIIIB() {
    // Come IIIA O pneumoperitoneo
    return checkStageIIIA() || selectedCriteria.radiological.pneumoperitoneum;
}

function updateStageDisplay(stage, satisfied) {
    var checkElement = document.getElementById('stage-' + stage + '-check');
    var statusElement = checkElement.querySelector('.stage-status');
    
    if (satisfied) {
        checkElement.className = 'stage-check stage-' + stage;
        statusElement.textContent = 'SODDISFATTO';
        statusElement.className = 'stage-status status-met';
    } else {
        checkElement.className = 'stage-check not-met';
        statusElement.textContent = 'NON SODDISFATTO';
        statusElement.className = 'stage-status status-not-met';
    }
}

function getHighestSatisfiedStage(stages) {
    var stageOrder = ['iiib', 'iiia', 'iib', 'iia', 'ib', 'ia'];
    
    for (var i = 0; i < stageOrder.length; i++) {
        if (stages[stageOrder[i]]) {
            return stageOrder[i];
        }
    }
    return null;
}

function updateFinalDiagnosis(stage) {
    var diagnosisElement = document.getElementById('final-diagnosis');
    var stageLabels = {
        'ia': 'Stadio IA - NEC Sospetta',
        'ib': 'Stadio IB - NEC Sospetta',
        'iia': 'Stadio IIA - NEC Definitiva Lieve',
        'iib': 'Stadio IIB - NEC Definitiva Moderata',
        'iiia': 'Stadio IIIA - NEC Severa, Intestino Intatto',
        'iiib': 'Stadio IIIB - NEC Severa, Intestino Perforato'
    };
    
    if (stage) {
        diagnosisElement.textContent = '📋 DIAGNOSI NEC: ' + stageLabels[stage];
        diagnosisElement.className = 'final-diagnosis diagnosis-' + stage;
    } else {
        diagnosisElement.textContent = '🔍 DIAGNOSI: Criteri insufficienti per stadiazione NEC';
        diagnosisElement.className = 'final-diagnosis diagnosis-none';
    }
}

function resetCalculator() {
    // Reset tutti i criteri selezionati
    selectedCriteria = {
        systemic: {},
        intestinal: {},
        radiological: {}
    };
    
    // Rimuovi tutte le selezioni visive
    var allItems = document.querySelectorAll('.criterion-item');
    for (var i = 0; i < allItems.length; i++) {
        allItems[i].classList.remove('selected');
    }
    
    // Reset status gruppi
    updateGroupStatus('systemic');
    updateGroupStatus('intestinal');
    updateGroupStatus('radiological');
    
    // Reset valutazione stadi
    evaluateStages();
}

function printResults() {
    window.print();
}

// Inizializzazione
updateGroupStatus('systemic');
updateGroupStatus('intestinal');
updateGroupStatus('radiological');
evaluateStages();
</script>
</html>