1
|
Scott MJ. Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation. Anesth Analg 2024; 138:713-724. [PMID: 38153876 PMCID: PMC10916753 DOI: 10.1213/ane.0000000000006789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/30/2023]
Abstract
In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review the science and use expert consensus to produce best practice recommendations to address the issue of perioperative hemodynamic instability. After expert presentations, a modified Delphi process using discussions, voting, and feedback resulted in 17 recommendations regarding advancing the perioperative care of the patient at risk of, or with, hemodynamic instability. There were 17 high-level recommendations. These recommendations related to the following 7 domains: Current Knowledge (5 statements); Preventing Hemodynamic Instability-Related Harm During All Phases of Care (4 statements); Data-Driven Quality Improvement (3 statements); Informing Patients (2 statements); The Importance of Technology (1 statement); Launch a National Campaign (1 statement); and Advancing the Science (1 statement). A summary of the recommendations is presented in Table 1 .
Collapse
Affiliation(s)
- Michael J. Scott
- From the Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Anesthesia Critical Care and Pain Medicine, University College London, London, United Kingdom
| |
Collapse
|
2
|
Kim YK, Koo JH, Lee SJ, Song HS, Lee M. Explainable Artificial Intelligence Warning Model Using an Ensemble Approach for In-Hospital Cardiac Arrest Prediction: Retrospective Cohort Study. J Med Internet Res 2023; 25:e48244. [PMID: 38133922 PMCID: PMC10770782 DOI: 10.2196/48244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/19/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Cardiac arrest (CA) is the leading cause of death in critically ill patients. Clinical research has shown that early identification of CA reduces mortality. Algorithms capable of predicting CA with high sensitivity have been developed using multivariate time series data. However, these algorithms suffer from a high rate of false alarms, and their results are not clinically interpretable. OBJECTIVE We propose an ensemble approach using multiresolution statistical features and cosine similarity-based features for the timely prediction of CA. Furthermore, this approach provides clinically interpretable results that can be adopted by clinicians. METHODS Patients were retrospectively analyzed using data from the Medical Information Mart for Intensive Care-IV database and the eICU Collaborative Research Database. Based on the multivariate vital signs of a 24-hour time window for adults diagnosed with heart failure, we extracted multiresolution statistical and cosine similarity-based features. These features were used to construct and develop gradient boosting decision trees. Therefore, we adopted cost-sensitive learning as a solution. Then, 10-fold cross-validation was performed to check the consistency of the model performance, and the Shapley additive explanation algorithm was used to capture the overall interpretability of the proposed model. Next, external validation using the eICU Collaborative Research Database was performed to check the generalization ability. RESULTS The proposed method yielded an overall area under the receiver operating characteristic curve (AUROC) of 0.86 and area under the precision-recall curve (AUPRC) of 0.58. In terms of the timely prediction of CA, the proposed model achieved an AUROC above 0.80 for predicting CA events up to 6 hours in advance. The proposed method simultaneously improved precision and sensitivity to increase the AUPRC, which reduced the number of false alarms while maintaining high sensitivity. This result indicates that the predictive performance of the proposed model is superior to the performances of the models reported in previous studies. Next, we demonstrated the effect of feature importance on the clinical interpretability of the proposed method and inferred the effect between the non-CA and CA groups. Finally, external validation was performed using the eICU Collaborative Research Database, and an AUROC of 0.74 and AUPRC of 0.44 were obtained in a general intensive care unit population. CONCLUSIONS The proposed framework can provide clinicians with more accurate CA prediction results and reduce false alarm rates through internal and external validation. In addition, clinically interpretable prediction results can facilitate clinician understanding. Furthermore, the similarity of vital sign changes can provide insights into temporal pattern changes in CA prediction in patients with heart failure-related diagnoses. Therefore, our system is sufficiently feasible for routine clinical use. In addition, regarding the proposed CA prediction system, a clinically mature application has been developed and verified in the future digital health field.
Collapse
Affiliation(s)
- Yun Kwan Kim
- Department of Research and Development, Seers Technology Co, Ltd, Pyeongtaek, Republic of Korea
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Ja Hyung Koo
- Department of Research and Development, Seers Technology Co, Ltd, Pyeongtaek, Republic of Korea
| | - Sun Jung Lee
- Department of Research and Development, Seers Technology Co, Ltd, Pyeongtaek, Republic of Korea
| | - Hee Seok Song
- Department of Research and Development, Seers Technology Co, Ltd, Pyeongtaek, Republic of Korea
| | - Minji Lee
- Department of Biomedical Software Engineering, The Catholic University of Korea, Gyeonggi, Republic of Korea
| |
Collapse
|
3
|
İlhan B, Bozdereli Berikol G, Doğan H. The predictive value of modified risk scores in patients with acute exacerbation of COPD: a retrospective cohort study. Intern Emerg Med 2022; 17:2119-2127. [PMID: 35854207 PMCID: PMC9296366 DOI: 10.1007/s11739-022-03048-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
This study aims to evaluate the performance of CREWS (Chronic Respiratory Early Warning Score), S-NEWS (Salford-National Early Warning Score), qNEWS (Quick National Early Warning Score), NEWS (National Early Warning Score), and qSOFA (Quick Sequential Organ Failure Assessment) scores in predicting mortality, intensive care unit (ICU) admission and the need for mechanical ventilation (MV) of patients presented with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1 and December 31, 2019. The patients with AECOPD and aged ≥ 18 were included. Patients who were transferred from another center and whose data could not be reached were excluded. Demographic information, comorbid diseases, variables of the scores, laboratory results, and outcomes were recorded. A total of 575 consecutive patients were included. The 30-day mortality, ICU admission, and MV need rate were 5.7% (n = 33), 9.6% (n = 55), and 13.7% (n = 79), respectively. Each score had moderate-to-excellent performance in predicting MV need and ICU admission, while their performance in predicting mortality was poor. CREWS is the most successful score in predicting 30-day mortality (AUC 0.695), ICU admission (AUC 0.841), and MV need (AUC 0.924). ICU admission, age, and creatinine levels were associated with mortality (p < 0.05). All scores have better performance in predicting ICU admission and MV need than mortality. ICU admission, age, and creatinine levels may be the predictors of mortality among AECOPD patients.
Collapse
Affiliation(s)
- Buğra İlhan
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Göksu Bozdereli Berikol
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Halil Doğan
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Forster S, McKeever TM, Churpek M, Gonem S, Shaw D. Predicting outcome in acute respiratory admissions using patterns of National Early Warning Scores. Clin Med (Lond) 2022; 22:409-415. [PMID: 38589061 PMCID: PMC9595013 DOI: 10.7861/clinmed.2022-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Accurately predicting risk of patient deterioration is vital. Altered physiology in chronic disease affects the prognostic ability of vital signs based early warning score systems. We aimed to assess the potential of early warning score patterns to improve outcome prediction in patients with respiratory disease. METHODS Patients admitted under respiratory medicine between April 2015 and March 2017 had their National Early Warning Score 2 (NEWS2) calculated retrospectively from vital sign observations. Prediction models (including temporal patterns) were constructed and assessed for ability to predict death within 24 hours using all observations collected not meeting exclusion criteria. The best performing model was tested on a validation cohort of admissions from April 2017 to March 2019. RESULTS The derivation cohort comprised 7,487 admissions and the validation cohort included 8,739 admissions. Adding the maximum score in the preceding 24 hours to the most recently recorded NEWS2 improved area under the receiver operating characteristic curve for death in 24 hours from 0.888 (95% confidence interval (CI) 0.881-0.895) to 0.902 (95% CI 0.895-0.909) in the overall respiratory population. CONCLUSION Combining the most recently recorded score and the maximum NEWS2 score from the preceding 24 hours demonstrated greater accuracy than using snapshot NEWS2. This simple inclusion of a scoring pattern should be considered in future iterations of early warning scoring systems.
Collapse
Affiliation(s)
- Sarah Forster
- Nottingham University Hospitals NHS Trust, Nottingham, UK and University of Nottingham School of Medicine, Nottingham, UK.
| | | | - Matthew Churpek
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA
| | - Sherif Gonem
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dominick Shaw
- Nottingham University Hospitals NHS Trust, Nottingham, UK and University of Nottingham School of Medicine, Nottingham, UK
| |
Collapse
|
5
|
Hwang SO, Cha KC, Jung WJ, Roh YI, Kim TY, Chung SP, Kim YM, Park JD, Kim HS, Lee MJ, Na SH, Cho GC, Kim ARE. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 2. Environment for cardiac arrest survival and the chain of survival. Clin Exp Emerg Med 2021; 8:S8-S14. [PMID: 34034446 PMCID: PMC8171179 DOI: 10.15441/ceem.21.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/02/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young-Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Youn Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | | |
Collapse
|
6
|
Naito T, Hayashi K, Hsu HC, Aoki K, Nagata K, Arai M, Nakada TA, Suzaki S, Hayashi Y, Fujitani S. Validation of National Early Warning Score for predicting 30-day mortality after rapid response system activation in Japan. Acute Med Surg 2021; 8:e666. [PMID: 34026233 PMCID: PMC8122242 DOI: 10.1002/ams2.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/27/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022] Open
Abstract
Aim Although rapid response systems (RRS) are used to prevent adverse events, Japan reportedly has low activation rates and high mortality rates. The National Early Warning Score (NEWS) could provide a solution, but it has not been validated in Japan. We aimed to validate NEWS for Japanese patients. Methods This retrospective observational study included data of 2,255 adult patients from 33 facilities registered in the In‐Hospital Emergency Registry in Japan between January 2014 and March 2018. The primary evaluated outcome was mortality rate 30 days after RRS activation. Accuracy of NEWS was analyzed with the correlation coefficient and area under the receiver operating characteristic curve. Prediction weights of NEWS parameters were then analyzed using multiple logistic regression and a machine learning method, classification and regression trees. Results The correlation coefficient of NEWS for 30‐day mortality rate was 0.95 (95% confidence interval [CI], 0.88–0.98) and the area under the receiver operating characteristic curve was 0.668 (95% CI, 0.642–0.693). Sensitivity and specificity values with a cut‐off score of 7 were 89.8% and 45.1%, respectively. Regarding prediction values of each parameter, oxygen saturation showed the highest odds ratio of 1.36 (95% CI, 1.25–1.48), followed by altered mental status 1.23 (95% CI, 1.14–1.32), heart rate 1.21 (95% CI, 1.09–1.34), systolic blood pressure 1.12 (95% CI, 1.04–1.22), and respiratory rate 1.03 (95% CI, 1.05–1.26). Body temperature and oxygen supplementation were not significantly associated. Classification and regression trees showed oxygen saturation as the most heavily weighted parameter, followed by altered mental status and respiratory rate. Conclusions National Early Warning Score could stratify 30‐day mortality risk following RRS activation in Japanese patients.
Collapse
Affiliation(s)
- Takaki Naito
- Department of Emergency and Critical Care Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Kuniyoshi Hayashi
- Graduate School of Public Health St. Luke's International University Tokyo Japan
| | - Hsiang-Chin Hsu
- Department of Emergency Medicine National Cheng Kung University Tainan City Taiwan
| | - Kazuhiro Aoki
- Department of Anesthesiology and Intensive Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Kazuma Nagata
- Department of Respiratory Medicine Kobe City Medical Center General Hospital Hyogo Japan
| | - Masayasu Arai
- Department of Anesthesiology Kitasato University School of Medicine Kanagawa Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Shinichiro Suzaki
- Department of Emergency and Critical Care Medicine Japanese Red Cross Musashino Hospital Tokyo Japan
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine Kameda Medical Center Chiba Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine St. Marianna University School of Medicine Kanagawa Japan
| | | |
Collapse
|
7
|
Novel Approaches to Risk Stratification of In-Hospital Cardiac Arrest. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00667-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Emmanuel A. Clinical Medicine 2020 - putting policy into practice. Clin Med (Lond) 2020; 20:1. [PMID: 31941724 PMCID: PMC6964172 DOI: 10.7861/clinmed.ed.20.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|