Automatically-Computed Prehospital Severity Scores are Equivalent to Scores Based on Medic Documentation

Reisner, Andrew; Chen, Liangyou; McKenna, Thomas M.; Reifman, Jaques

doi:10.1097/ta.0b013e31815eb142

Cited by 22 publications

(27 citation statements)

References 31 publications

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“…21 • The blood pressure reliability algorithm compares the HR measured by an oscillometric noninvasive blood pressure cuff versus the ECG HR and also checks that the relationships between SBP, MAP, and DBP are physiologic. 22 Reliable SBP, as determined by this algorithm, was found to be statistically superior to unreliable SBP as a predictor of major hemorrhage.…”

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confidence: 99%

Exploration of Prehospital Vital Sign Trends for the Prediction of Trauma Outcomes

Chen

Reisner

Gribok

et al. 2009

Prehospital Emergency Care

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Objectives. We explored whether there are diagnostically useful temporal trends in prehospital vital signs of trauma patients. Methods. Vital signs were monitored during transport to a level I trauma center and electronically archived. Retrospectively, we identified reliable vital signs recorded from the 0-to 7-minute interval and from the 14-to 21-minute interval during transport, and, for each subject, we computed the temporal differences between the two intervals' vital signs, the intrasubject 95% data ranges, the values during the initial 2 minutes, and the 21-minute overall means. We tested for differences between subjects with major hemorrhage versus control subjects, and computed receiveroperating characteristic (ROC) curves. We conducted sensitivity analyses, exploring alternative clinical outcomes, temporal windows, and methods of identifying reliable data. Results. Comparing major hemorrhage cases versus controls, there were no discriminatory differences in temporal vital sign trends. Hemorrhage cases had significantly wider intrasubject data ranges for systolic blood pressure (SBP), respiratory rate (RR), and shock index (SI) versus controls. All results were consistent in several sensitivity analyses. Conclusions. Our findings add to a growing body of evidence that prehospital vital sign trends over 21 minutes or less are unlikely to be diagnostically useful because of substantial nondirectional fluctuations in vital signs that would obscure any subtle, progressive temporal trends. SBP, RR, and SI values were significantly different for high-acuity patients, and had more variability. Taken together, these findings suggest that higher-acuity patients experience episodes of instability rather than gradual, steady decline. Measures that account for data variability, such as taking the average of multiple measurements, may improve the diagnostic utility of prehospital vital signs.

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confidence: 99%

Exploration of Prehospital Vital Sign Trends for the Prediction of Trauma Outcomes

Chen

Reisner

Gribok

et al. 2009

Prehospital Emergency Care

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“…Vital sign data rated 2 or 3 were considered reliable; otherwise, they were unreliable. Detailed descriptions of these algorithms have been previously reported [28][29][30]. Here, we provide an overview of the methodology.…”

Section: Vital Sign Reliabilitymentioning

confidence: 98%

“…The BP reliability algorithm determined if the ratio between SBP, DBP, and mean pressure is physiologic and if the HR measured by the inflatable oscillometric cuff matches the ECG HR [29]. The algorithm does not attempt to distinguish between unequal HRs because of motion artifact vs unequal HRs because of nonperfusing electrical beats, for example, premature contractions; in the latter case, it would be possible for reliable BP data to be misclassified as unreliable.…”

Section: Vital Sign Reliabilitymentioning

confidence: 99%

The association between vital signs and major hemorrhagic injury is significantly improved after controlling for sources of measurement variability

Reisner¹,

Chen²,

Reifman³

2012

Journal of Critical Care

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“…We previously found that automated techniques are diagnostically equivalent to prehospital severity scores based on medics' documentation. 15 In this case, we focused on the identification of hemorrhage because blood loss is 1 of the 2 primary reasons why trauma patients die, 35,36 but in many cases it can be treated effectively with blood transfusion and surgical hemorrhage control. We speculate that formal quantitative analysis of continual vital signs may be able to supplement today's convention, which relies on informal clinician judgments to integrate vital-sign data with other important clinical data.…”

Section: Discussionmentioning

confidence: 99%

Are Standard Diagnostic Test Characteristics Sufficient for the Assessment of Continual Patient Monitoring?

et al. 2012

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Background. For diagnostic processes involving continual measurements from a single patient, conventional test characteristics, such as sensitivity and specificity, do not consider decision consistency, which might be a distinct, clinically relevant test characteristic. Objective. The authors investigated the performance of a decision-support classifier for the diagnosis of traumatic injury with blood loss, implemented with three different data-processing methods. For each method, they computed standard diagnostic test characteristics and novel metrics related to decision consistency and latency. Setting. Prehospital air ambulance transport. Patients. A total of 557 trauma patients. Design. Continually monitored vital-sign data from 279 patients (50%) were randomly selected for classifier development, and the remaining were used for testing. Three data-processing methods were evaluated over 16 min of patient monitoring: a 2-min moving window, time averaging, and postprocessing with the sequential probability ratio test (SPRT). Measurements. Sensitivity and specificity were computed. Consistency was quantified through cumulative counts of decision changes over time and the fraction of patients affected by false alarms. Latency was evaluated by the fraction of patients without a decision. Results. All 3 methods showed very similar final sensitivities and specificities. Yet, there were significant differences in terms of the fraction of patients affected by false alarms, decision changes through time, and latency. For instance, use of the SPRT led to a 75% reduction in the number of decision changes and a 36% reduction in the number of patients affected by false alarms, at the expense of 3% unresolved final decisions. Conclusion. The proposed metrics of decision consistency and decision latency provided additional information beyond what could be obtained from test sensitivity and specificity and are likely to be clinically relevant in some applications involving temporal decision making.

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Automatically-Computed Prehospital Severity Scores are Equivalent to Scores Based on Medic Documentation

Cited by 22 publications

References 31 publications

Exploration of Prehospital Vital Sign Trends for the Prediction of Trauma Outcomes

Exploration of Prehospital Vital Sign Trends for the Prediction of Trauma Outcomes

The association between vital signs and major hemorrhagic injury is significantly improved after controlling for sources of measurement variability

Are Standard Diagnostic Test Characteristics Sufficient for the Assessment of Continual Patient Monitoring?

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