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Rashedi N, Sun Y, Vaze V, Shah P, Halter R, Elliott JT, Paradis NA. Prediction of Occult Hemorrhage in the Lower Body Negative Pressure Model: Initial Validation of Machine Learning Approaches. Mil Med 2024; 189:e1629-e1636. [PMID: 38537150 DOI: 10.1093/milmed/usae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Detection of occult hemorrhage (OH) before progression to clinically apparent changes in vital signs remains an important clinical problem in managing trauma patients. The resource-intensiveness associated with continuous clinical patient monitoring and rescue from frank shock makes accurate early detection and prediction with noninvasive measurement technology a desirable innovation. Despite significant efforts directed toward the development of innovative noninvasive diagnostics, the implementation and performance of the newest bedside technologies remain inadequate. This poor performance may reflect the limitations of univariate systems based on one sensor in one anatomic location. It is possible that when signals are measured with multiple modalities in multiple locations, the resulting multivariate anatomic and temporal patterns of measured signals may provide additional discriminative power over single technology univariate measurements. We evaluated the potential superiority of multivariate methods over univariate methods. Additionally, we utilized machine learning-based models to compare the performance of noninvasive-only to noninvasive-plus-invasive measurements in predicting the onset of OH. MATERIALS AND METHODS We applied machine learning methods to preexisting datasets derived using the lower body negative pressure human model of simulated hemorrhage. Employing multivariate measured physiological signals, we investigated the extent to which machine learning methods can effectively predict the onset of OH. In particular, we applied 2 ensemble learning methods, namely, random forest and gradient boosting. RESULTS Analysis of precision, recall, and area under the receiver operating characteristic curve showed a superior performance of multivariate approach to that of the univariate ones. In addition, when using both invasive and noninvasive features, random forest classifier had a recall 95% confidence interval (CI) of 0.81 to 0.86 with a precision 95% CI of 0.65 to 0.72. Interestingly, when only noninvasive features were employed, the results worsened only slightly to a recall 95% CI of 0.80 to 0.85 and a precision 95% CI of 0.61 to 0.73. CONCLUSIONS Multivariate ensemble machine learning-based approaches for the prediction of hemodynamic instability appear to hold promise for the development of effective solutions. In the lower body negative pressure multivariate hemorrhage model, predictions based only on noninvasive measurements performed comparably to those using both invasive and noninvasive measurements.
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Affiliation(s)
- Navid Rashedi
- Department of Engineering Sciences, Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | - Yifei Sun
- Department of Engineering Sciences, Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | - Vikrant Vaze
- Department of Engineering Sciences, Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | - Parikshit Shah
- Department of Electrical Engineering and Computer Science, Insight Research, Emerald Hills, CA 94065, USA
| | - Ryan Halter
- Department of Engineering Sciences, Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | - Jonathan T Elliott
- Department of Emergency Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Norman A Paradis
- Department of Emergency Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
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Wohlgemut JM, Pisirir E, Stoner RS, Kyrimi E, Christian M, Hurst T, Marsh W, Perkins ZB, Tai NRM. Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome. Trauma Surg Acute Care Open 2024; 9:e001214. [PMID: 38274019 PMCID: PMC10806521 DOI: 10.1136/tsaco-2023-001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
Background Hemorrhage is the most common cause of potentially preventable death after injury. Early identification of patients with major hemorrhage (MH) is important as treatments are time-critical. However, diagnosis can be difficult, even for expert clinicians. This study aimed to determine how accurate clinicians are at identifying patients with MH in the prehospital setting. A second aim was to analyze factors associated with missed and overdiagnosis of MH, and the impact on mortality. Methods Retrospective evaluation of consecutive adult (≥16 years) patients injured in 2019-2020, assessed by expert trauma clinicians in a mature prehospital trauma system, and admitted to a major trauma center (MTC). Clinicians decided to activate the major hemorrhage protocol (MHPA) or not. This decision was compared with whether patients had MH in hospital, defined as the critical admission threshold (CAT+): administration of ≥3 U of red blood cells during any 60-minute period within 24 hours of injury. Multivariate logistical regression analyses were used to analyze factors associated with diagnostic accuracy and mortality. Results Of the 947 patients included in this study, 138 (14.6%) had MH. MH was correctly diagnosed in 97 of 138 patients (sensitivity 70%) and correctly excluded in 764 of 809 patients (specificity 94%). Factors associated with missed diagnosis were penetrating mechanism (OR 2.4, 95% CI 1.2 to 4.7) and major abdominal injury (OR 4.0; 95% CI 1.7 to 8.7). Factors associated with overdiagnosis were hypotension (OR 0.99; 95% CI 0.98 to 0.99), polytrauma (OR 1.3, 95% CI 1.1 to 1.6), and diagnostic uncertainty (OR 3.7, 95% CI 1.8 to 7.3). When MH was missed in the prehospital setting, the risk of mortality increased threefold, despite being admitted to an MTC. Conclusion Clinical assessment has only a moderate ability to identify MH in the prehospital setting. A missed diagnosis of MH increased the odds of mortality threefold. Understanding the limitations of clinical assessment and developing solutions to aid identification of MH are warranted. Level of evidence Level III-Retrospective study with up to two negative criteria. Study type Original research; diagnostic accuracy study.
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Affiliation(s)
- Jared M Wohlgemut
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Erhan Pisirir
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Rebecca S Stoner
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Evangelia Kyrimi
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | | | | | - William Marsh
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Zane B Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Nigel R M Tai
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
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Wohlgemut JM, Pisirir E, Kyrimi E, Stoner RS, Marsh W, Perkins ZB, Tai NRM. Methods used to evaluate usability of mobile clinical decision support systems for healthcare emergencies: a systematic review and qualitative synthesis. JAMIA Open 2023; 6:ooad051. [PMID: 37449057 PMCID: PMC10336299 DOI: 10.1093/jamiaopen/ooad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The aim of this study was to determine the methods and metrics used to evaluate the usability of mobile application Clinical Decision Support Systems (CDSSs) used in healthcare emergencies. Secondary aims were to describe the characteristics and usability of evaluated CDSSs. Materials and Methods A systematic literature review was conducted using Pubmed/Medline, Embase, Scopus, and IEEE Xplore databases. Quantitative data were descriptively analyzed, and qualitative data were described and synthesized using inductive thematic analysis. Results Twenty-three studies were included in the analysis. The usability metrics most frequently evaluated were efficiency and usefulness, followed by user errors, satisfaction, learnability, effectiveness, and memorability. Methods used to assess usability included questionnaires in 20 (87%) studies, user trials in 17 (74%), interviews in 6 (26%), and heuristic evaluations in 3 (13%). Most CDSS inputs consisted of manual input (18, 78%) rather than automatic input (2, 9%). Most CDSS outputs comprised a recommendation (18, 78%), with a minority advising a specific treatment (6, 26%), or a score, risk level or likelihood of diagnosis (6, 26%). Interviews and heuristic evaluations identified more usability-related barriers and facilitators to adoption than did questionnaires and user testing studies. Discussion A wide range of metrics and methods are used to evaluate the usability of mobile CDSS in medical emergencies. Input of information into CDSS was predominantly manual, impeding usability. Studies employing both qualitative and quantitative methods to evaluate usability yielded more thorough results. Conclusion When planning CDSS projects, developers should consider multiple methods to comprehensively evaluate usability.
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Affiliation(s)
- Jared M Wohlgemut
- Corresponding Author: Jared M. Wohlgemut, MSc, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark St, London E1 2AT, UK;
| | - Erhan Pisirir
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Evangelia Kyrimi
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Rebecca S Stoner
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - William Marsh
- Department of Electrical Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Zane B Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Nigel R M Tai
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Trauma Service, Royal London Hospital, Barts NHS Health Trust, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine, Birmingham, UK
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Stallings JD, Laxminarayan S, Yu C, Kapela A, Frock A, Cap AP, Reisner AT, Reifman J. APPRAISE-HRI: AN ARTIFICIAL INTELLIGENCE ALGORITHM FOR TRIAGE OF HEMORRHAGE CASUALTIES. Shock 2023; 60:199-205. [PMID: 37335312 PMCID: PMC10476583 DOI: 10.1097/shk.0000000000002166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/12/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
ABSTRACT Background: Hemorrhage remains the leading cause of death on the battlefield. This study aims to assess the ability of an artificial intelligence triage algorithm to automatically analyze vital-sign data and stratify hemorrhage risk in trauma patients. Methods: Here, we developed the APPRAISE-Hemorrhage Risk Index (HRI) algorithm, which uses three routinely measured vital signs (heart rate and diastolic and systolic blood pressures) to identify trauma patients at greatest risk of hemorrhage. The algorithm preprocesses the vital signs to discard unreliable data, analyzes reliable data using an artificial intelligence-based linear regression model, and stratifies hemorrhage risk into low (HRI:I), average (HRI:II), and high (HRI:III). Results: To train and test the algorithm, we used 540 h of continuous vital-sign data collected from 1,659 trauma patients in prehospital and hospital (i.e., emergency department) settings. We defined hemorrhage cases (n = 198) as those patients who received ≥1 unit of packed red blood cells within 24 h of hospital admission and had documented hemorrhagic injuries. The APPRAISE-HRI stratification yielded a hemorrhage likelihood ratio (95% confidence interval) of 0.28 (0.13-0.43) for HRI:I, 1.00 (0.85-1.15) for HRI:II, and 5.75 (3.57-7.93) for HRI:III, suggesting that patients categorized in the low-risk (high-risk) category were at least 3-fold less (more) likely to have hemorrhage than those in the average trauma population. We obtained similar results in a cross-validation analysis. Conclusions: The APPRAISE-HRI algorithm provides a new capability to evaluate routine vital signs and alert medics to specific casualties who have the highest risk of hemorrhage, to optimize decision-making for triage, treatment, and evacuation.
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Affiliation(s)
| | - Srinivas Laxminarayan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Fort Detrick, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Chenggang Yu
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Fort Detrick, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Adam Kapela
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Fort Detrick, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Andrew Frock
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Fort Detrick, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Andrew P. Cap
- US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Andrew T. Reisner
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, US Army Medical Research and Development Command, Fort Detrick, Maryland
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Choi Y, Park JH, Hong KJ, Ro YS, Song KJ, Shin SD. Development and validation of a prehospital-stage prediction tool for traumatic brain injury: a multicentre retrospective cohort study in Korea. BMJ Open 2022; 12:e055918. [PMID: 35022177 PMCID: PMC8756263 DOI: 10.1136/bmjopen-2021-055918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Predicting diagnosis and prognosis of traumatic brain injury (TBI) at the prehospital stage is challenging; however, using comprehensive prehospital information and machine learning may improve the performance of the predictive model. We developed and tested predictive models for TBI that use machine learning algorithms using information that can be obtained in the prehospital stage. DESIGN This was a multicentre retrospective study. SETTING AND PARTICIPANTS This study was conducted at three tertiary academic emergency departments (EDs) located in an urban area of South Korea. The data from adult patients with severe trauma who were assessed by emergency medical service providers and transported to three participating hospitals between 2014 to 2018 were analysed. RESULTS We developed and tested five machine learning algorithms-logistic regression analyses, extreme gradient boosting, support vector machine, random forest and elastic net (EN)-to predict TBI, TBI with intracranial haemorrhage or injury (TBI-I), TBI with ED or admission result of admission or transferred (TBI with non-discharge (TBI-ND)) and TBI with ED or admission result of death (TBI-D). A total of 1169 patients were included in the final analysis, and the proportions of TBI, TBI-I, TBI-ND and TBI-D were 24.0%, 21.5%, 21.3% and 3.7%, respectively. The EN model yielded an area under receiver-operator curve of 0.799 for TBI, 0.844 for TBI-I, 0.811 for TBI-ND and 0.871 for TBI-D. The EN model also yielded the highest specificity and significant reclassification improvement. Variables related to loss of consciousness, Glasgow Coma Scale and light reflex were the three most important variables to predict all outcomes. CONCLUSION Our results inform the diagnosis and prognosis of TBI. Machine learning models resulted in significant performance improvement over that with logistic regression analyses, and the best performing model was EN.
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Affiliation(s)
- Yeongho Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
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Li K, Wu H, Pan F, Chen L, Feng C, Liu Y, Hui H, Cai X, Che H, Ma Y, Li T. A Machine Learning-Based Model to Predict Acute Traumatic Coagulopathy in Trauma Patients Upon Emergency Hospitalization. Clin Appl Thromb Hemost 2020; 26:1076029619897827. [PMID: 31908189 PMCID: PMC7098202 DOI: 10.1177/1076029619897827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Acute traumatic coagulopathy (ATC) is an extremely common but silent murderer; this condition presents early after trauma and impacts approximately 30% of severely injured patients who are admitted to emergency departments (EDs). Given that conventional coagulation indicators usually require more than 1 hour after admission to yield results—a limitation that frequently prevents the ability for clinicians to make appropriate interventions during the optimal therapeutic window—it is clearly of vital importance to develop prediction models that can rapidly identify ATC; such models would also facilitate ancillary resource management and clinical decision support. Using the critical care Emergency Rescue Database and further collected data in ED, a total of 1385 patients were analyzed and cases with initial international normalized ratio (INR) values >1.5 upon admission to the ED met the defined diagnostic criteria for ATC; nontraumatic conditions with potentially disordered coagulation systems were excluded. A total of 818 individuals were collected from Emergency Rescue Database as derivation cohorts, then were split 7:3 into training and test data sets. A Pearson correlation matrix was used to initially identify likely key clinical features associated with ATC, and analysis of data distributions was undertaken prior to the selection of suitable modeling tools. Both machine learning (random forest) and traditional logistic regression were deployed for prediction modeling of ATC. After the model was built, another 587 patients were further collected in ED as validation cohorts. The ATC prediction models incorporated red blood cell count, Shock Index, base excess, lactate, diastolic blood pressure, and potential of hydrogen. Of 818 trauma patients filtered from the database, 747 (91.3%) patients did not present ATC (INR ≤ 1.5) and 71 (8.7%) patients had ATC (INR > 1.5) upon admission to the ED. Compared to the logistic regression model, the model based on the random forest algorithm showed better accuracy (94.0%, 95% confidence interval [CI]: 0.922-0.954 to 93.5%, 95% CI: 0.916-0.95), precision (93.3%, 95% CI: 0.914-0.948 to 93.1%, 95% CI: 0.912-0.946), F1 score (93.4%, 95% CI: 0.915-0.949 to 92%, 95% CI: 0.9-0.937), and recall score (94.0%, 95% CI: 0.922-0.954 to 93.5%, 95% CI: 0.916-0.95) but yielded lower area under the receiver operating characteristic curve (AU-ROC) (0.810, 95% CI: 0.673-0.918 to 0.849, 95% CI: 0.732-0.944) for predicting ATC in the trauma patients. The result is similar in the validation cohort. The values for classification accuracy, precision, F1 score, and recall score of random forest model were 0.916, 0.907, 0.901, and 0.917, while the AU-ROC was 0.830. The values for classification accuracy, precision, F1 score, and recall score of logistic regression model were 0.905, 0.887, 0.883, and 0.905, while the AU-ROC was 0.858. We developed and validated a prediction model based on objective and rapidly accessible clinical data that very confidently identify trauma patients at risk for ATC upon their arrival to the ED. Beyond highlighting the value of ED initial laboratory tests and vital signs when used in combination with data analysis and modeling, our study illustrates a practical method that should greatly facilitates both warning and guided target intervention for ATC.
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Affiliation(s)
- Kaiyuan Li
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huitao Wu
- National Engineering Laboratory for Medical Big Data Application Technology, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fei Pan
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Li Chen
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Cong Feng
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yihao Liu
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hui Hui
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoyu Cai
- Department of Blood Transfusion, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hebin Che
- National Engineering Laboratory for Medical Big Data Application Technology, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yulong Ma
- Anesthesia and Operation Center, The First Medical Center to Chinese PLA General Hospital, Beijing, China
| | - Tanshi Li
- Department of Emergency, The First Medical Center to Chinese People's Liberation Army General Hospital, Beijing, China
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Tachycardic and non-tachycardic responses in trauma patients with haemorrhagic injuries. Injury 2018; 49:1654-1660. [PMID: 29729820 DOI: 10.1016/j.injury.2018.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/11/2018] [Accepted: 04/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Analyses of large databases have demonstrated that the association between heart rate (HR) and blood loss is weaker than what is taught by Advanced Trauma Life Support training. However, those studies had limited ability to generate a more descriptive paradigm, because they only examined a single HR value per patient. METHODS In a comparative, retrospective analysis, we studied the temporal characteristics of HR through time in adult trauma patients with haemorrhage, based on documented injuries and transfusion of ≥3 units of red blood cells (RBCs). We analysed archived vital-sign data of up to 60 min during either pre-hospital or emergency department care. RESULTS We identified 133 trauma patients who met the inclusion criteria for major haemorrhage and 1640 control patients without haemorrhage. There were 55 haemorrhage patients with a normal median HR and 78 with tachycardia. Median ΔHR was -0.8 and +0.7 bpm per 10 min, respectively. Median time to documented hypotension was 8 and 5 min, respectively. RBCs were not significantly different; median volumes were 6 (IQR: 4-13) and 10 units (IQR: 5-16), respectively. Time-to-hypotension and mortality were not significantly different. Tachycardic patients were significantly younger (P < 0.05). Only 10 patients with normal HR developed transient/temporary tachycardia, and only 11 tachycardic patients developed a transient/temporary normal HR. CONCLUSIONS The current analysis suggests that some trauma patients with haemorrhage are continuously tachycardic while others have a normal HR. For both cohorts, hypotension typically develops within 30 min, without any consistent temporal increases or trends in HR.
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Bhandarkar P, Munivenkatappa A, Roy N, Kumar V, Samudrala VD, Kamble J, Agrawal A. On-admission blood pressure and pulse rate in trauma patients and their correlation with mortality: Cushing's phenomenon revisited. Int J Crit Illn Inj Sci 2017; 7:14-17. [PMID: 28382254 PMCID: PMC5364763 DOI: 10.4103/2229-5151.201950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Injury-induced alteration in initial physiological responses such as hypertension and heart rate (HR) has a significant effect on mortality. Research on such associations from our country-India is limited. The present study investigates the injury-induced early blood pressure (BP) and HR changes and their association with mortality. MATERIALS AND METHODS The data were selected from Towards Improved Trauma Care Outcomes collected from October 1, 2013, to July 24, 2014. Patients above 18 years of age with documented systolic BP (SBP) and HR were selected. BP was categorized into hypotension (SBP <90 mmHg), hypertension (SBP >140 mmHg), and normal (SBP 90-140 mmHg). HR was categorized into bradycardia (HR <60 beats/min [bpm]), tachycardia (HR >100 bpm), and normal (HR 60-100 bpm). These categories were compared with mortality. RESULTS A total of 10,200 patients were considered for the study. Mortality rate was 24%. Mortality among females was more than males. Patients with normal BP and HR had 20% of mortality. Mortality in patients with abnormal BP and HR findings was 36%. Mortality was higher among hypotension-bradycardia patients (80%) followed by hypertension-bradycardia patients (58%) and tachycardia hypotension patients (48%). Elderly patients were at higher risk of deaths with an overall mortality of 35% compared to 23% of adults. CONCLUSION The study reports that initial combination of hypotension-bradycardia had higher mortality rate. Specific precautions in prehospital care should be given to trauma patients with these findings. Further prospective study in detail should be considered for exploring this abnormality.
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Affiliation(s)
- Prashant Bhandarkar
- Department of Statistics, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Ashok Munivenkatappa
- VRDLN Project, National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, India
| | - Nobhojit Roy
- Department of Surgery, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Veda Dhruthy Samudrala
- Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | - Jyoti Kamble
- Department of Surgery, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Amit Agrawal
- Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
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Smith JB, Reisner AT, Edla S, Liu J, Liddle S, Reifman J. A platform for real-time acquisition and analysis of physiological data in hospital emergency departments. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:2678-81. [PMID: 25570542 DOI: 10.1109/embc.2014.6944174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
An opportunity exists for automated clinical decision support, in which raw source data from a conventional physiological monitoring system are continuously streamed to an independent analysis platform. Such a system would enable a wider range of functionality than offered by the source monitoring system. Although vendor solutions for this purpose are emerging, we developed our own system in order to control the expense and to permit forensic analysis of the internal core functionality of the system. In this report, we describe a platform that can provide decision support for trauma patients in an Emergency Department (ED). System evaluation spanned 39 days, and included a total of 2200 patient session hrs of real-time monitoring. We highlight the technical issues that we confronted, including protection of the core monitoring network, the real-time communication of electronic medical data, and the reliability of the real-time analysis. Detailing these nuanced technical issues may be valuable to other software developers or for those interested in investing in a vendor solution for similar functionality.
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Automated Analysis of Vital Signs to Identify Patients With Substantial Bleeding Before Hospital Arrival. Shock 2015; 43:429-36. [DOI: 10.1097/shk.0000000000000328] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prise en charge des pathologies réanimatoires et chirurgicales au cours des futures missions d’exploration spatiale. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0899-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reisner A, Chen X, Kumar K, Reifman J. Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury. J Neurotrauma 2014; 31:906-13. [DOI: 10.1089/neu.2013.3128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew Reisner
- Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Ft. Detrick, Maryland
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Xiaoxiao Chen
- Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Ft. Detrick, Maryland
| | - Kamal Kumar
- Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Ft. Detrick, Maryland
| | - Jaques Reifman
- Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Ft. Detrick, Maryland
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