Automated Analysis of Vital Signs to Identify Patients With Substantial Bleeding Before Hospital Arrival: A Feasibility Study
ABSTRACTTrauma outcomes are improved by protocols for substantial bleeding, typically activated after physician evaluation at a hospital. Previous analysis suggested that prehospital vital signs contained patterns indicating the presence or absence of substantial bleeding. In an observational study...
Gespeichert in:
| Veröffentlicht in: | Shock (Augusta, Ga.) Ga.), 2015-05, Vol.43 (5), p.429-436 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 436 |
|---|---|
| container_issue | 5 |
| container_start_page | 429 |
| container_title | Shock (Augusta, Ga.) |
| container_volume | 43 |
| creator | Liu, Jianbo Khitrov, Maxim Y Gates, Jonathan D Odom, Stephen R Havens, Joaquim M de Moya, Marc A Wilkins, Kevin Wedel, Suzanne K Kittell, Erin O Reifman, Jaques Reisner, Andrew T |
| description | ABSTRACTTrauma outcomes are improved by protocols for substantial bleeding, typically activated after physician evaluation at a hospital. Previous analysis suggested that prehospital vital signs contained patterns indicating the presence or absence of substantial bleeding. In an observational study of adults (aged ≥18 years) transported to level I trauma centers by helicopter, we investigated the diagnostic performance of the Automated Processing of the Physiological Registry for Assessment of Injury Severity (APPRAISE) system, a computational platform for real-time analysis of vital signs, for identification of substantial bleeding in trauma patients with explicitly hemorrhagic injuries. We studied 209 subjects prospectively and 646 retrospectively. In our multivariate analysis, prospective performance was not significantly different from retrospective. The APPRAISE system was 76% sensitive for 24-h packed red blood cells of 9 or more units (95% confidence interval, 59% – 89%) and significantly more sensitive (P < 0.05) than any prehospital Shock Index of 1.4 or higher; sensitivity, 59%; initial systolic blood pressure (SBP) less than 110 mmHg, 50%; and any prehospital SBP less than 90 mmHg, 50%. The APPRAISE specificity for 24-h packed red blood cells of 0 units was 87% (88% for any Shock Index ≥1.4, 88% for initial SBP |
| doi_str_mv | 10.1097/SHK.0000000000000328 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1674202544</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1674202544</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3058-a75c19885d4d54acfd33b76d128649704d5b21b5c64be053aff486ab5d7ed00f3</originalsourceid><addsrcrecordid>eNp9kE1P3DAQhi1UxPc_QMjHXgL-TLK9BVS6qEhUWlqOkROPWRdvvLWdohz475guVKiHzmVGM8-8o3kROqbklJJZdbaYfz0l74OzegvtUSlIQSQVH3JNKl4wztgu2o_xJyFM8Fm1g3aZLEsxq_keemrG5FcqgcbNoNwUbcTe4B82KYcX9n6IOHl8pWFI1kz4m0o2lxHf2bTEi7GLSeVJZs8dgLbDPT4H4wPguY_rPyJNCPa3cp9wgy9BRdtZZ9OEF2nU0yHaNspFOHrNB-j75efbi3lxffPl6qK5LnpOZF2oSvZ0VtdSCy2F6o3mvKtKTVmd36hI7naMdrIvRQdEcmWMqEvVSV2BJsTwA_Rxo7sO_tcIMbUrG3twTg3gx9jSshKMMClERsUG7YOPMYBp18GuVJhaStoX49tsfPuv8Xnt5PXC2K1A_116czoD9QZ49C5BiA9ufITQLkG5tPy_9jN485Af</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1674202544</pqid></control><display><type>article</type><title>Automated Analysis of Vital Signs to Identify Patients With Substantial Bleeding Before Hospital Arrival: A Feasibility Study</title><source>Journals@Ovid Ovid Autoload</source><source>MEDLINE</source><source>Journals@Ovid LWW Legacy Archive</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Liu, Jianbo ; Khitrov, Maxim Y ; Gates, Jonathan D ; Odom, Stephen R ; Havens, Joaquim M ; de Moya, Marc A ; Wilkins, Kevin ; Wedel, Suzanne K ; Kittell, Erin O ; Reifman, Jaques ; Reisner, Andrew T</creator><creatorcontrib>Liu, Jianbo ; Khitrov, Maxim Y ; Gates, Jonathan D ; Odom, Stephen R ; Havens, Joaquim M ; de Moya, Marc A ; Wilkins, Kevin ; Wedel, Suzanne K ; Kittell, Erin O ; Reifman, Jaques ; Reisner, Andrew T</creatorcontrib><description>ABSTRACTTrauma outcomes are improved by protocols for substantial bleeding, typically activated after physician evaluation at a hospital. Previous analysis suggested that prehospital vital signs contained patterns indicating the presence or absence of substantial bleeding. In an observational study of adults (aged ≥18 years) transported to level I trauma centers by helicopter, we investigated the diagnostic performance of the Automated Processing of the Physiological Registry for Assessment of Injury Severity (APPRAISE) system, a computational platform for real-time analysis of vital signs, for identification of substantial bleeding in trauma patients with explicitly hemorrhagic injuries. We studied 209 subjects prospectively and 646 retrospectively. In our multivariate analysis, prospective performance was not significantly different from retrospective. The APPRAISE system was 76% sensitive for 24-h packed red blood cells of 9 or more units (95% confidence interval, 59% – 89%) and significantly more sensitive (P < 0.05) than any prehospital Shock Index of 1.4 or higher; sensitivity, 59%; initial systolic blood pressure (SBP) less than 110 mmHg, 50%; and any prehospital SBP less than 90 mmHg, 50%. The APPRAISE specificity for 24-h packed red blood cells of 0 units was 87% (88% for any Shock Index ≥1.4, 88% for initial SBP <110 mmHg, and 90% for any prehospital SBP <90 mmHg). Median APPRAISE hemorrhage notification time was 20 min before arrival at the trauma center. In conclusion, APPRAISE identified bleeding before trauma center arrival. En route, this capability could allow medics to focus on direct patient care rather than the monitor and, via advance radio notification, could expedite hospital interventions for patients with substantial blood loss.</description><identifier>ISSN: 1073-2322</identifier><identifier>EISSN: 1540-0514</identifier><identifier>DOI: 10.1097/SHK.0000000000000328</identifier><identifier>PMID: 25664983</identifier><language>eng</language><publisher>United States: by the Shock Society</publisher><subject>Adolescent ; Adult ; Aged ; Air Ambulances ; Automation ; Blood Pressure - physiology ; Emergency Medical Services - methods ; Feasibility Studies ; Female ; Hemorrhage - diagnosis ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Retrospective Studies ; Shock - diagnosis ; Time Factors ; Trauma Centers ; Triage - methods ; Vital Signs ; Young Adult</subject><ispartof>Shock (Augusta, Ga.), 2015-05, Vol.43 (5), p.429-436</ispartof><rights>2015 by the Shock Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3058-a75c19885d4d54acfd33b76d128649704d5b21b5c64be053aff486ab5d7ed00f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25664983$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Jianbo</creatorcontrib><creatorcontrib>Khitrov, Maxim Y</creatorcontrib><creatorcontrib>Gates, Jonathan D</creatorcontrib><creatorcontrib>Odom, Stephen R</creatorcontrib><creatorcontrib>Havens, Joaquim M</creatorcontrib><creatorcontrib>de Moya, Marc A</creatorcontrib><creatorcontrib>Wilkins, Kevin</creatorcontrib><creatorcontrib>Wedel, Suzanne K</creatorcontrib><creatorcontrib>Kittell, Erin O</creatorcontrib><creatorcontrib>Reifman, Jaques</creatorcontrib><creatorcontrib>Reisner, Andrew T</creatorcontrib><title>Automated Analysis of Vital Signs to Identify Patients With Substantial Bleeding Before Hospital Arrival: A Feasibility Study</title><title>Shock (Augusta, Ga.)</title><addtitle>Shock</addtitle><description>ABSTRACTTrauma outcomes are improved by protocols for substantial bleeding, typically activated after physician evaluation at a hospital. Previous analysis suggested that prehospital vital signs contained patterns indicating the presence or absence of substantial bleeding. In an observational study of adults (aged ≥18 years) transported to level I trauma centers by helicopter, we investigated the diagnostic performance of the Automated Processing of the Physiological Registry for Assessment of Injury Severity (APPRAISE) system, a computational platform for real-time analysis of vital signs, for identification of substantial bleeding in trauma patients with explicitly hemorrhagic injuries. We studied 209 subjects prospectively and 646 retrospectively. In our multivariate analysis, prospective performance was not significantly different from retrospective. The APPRAISE system was 76% sensitive for 24-h packed red blood cells of 9 or more units (95% confidence interval, 59% – 89%) and significantly more sensitive (P < 0.05) than any prehospital Shock Index of 1.4 or higher; sensitivity, 59%; initial systolic blood pressure (SBP) less than 110 mmHg, 50%; and any prehospital SBP less than 90 mmHg, 50%. The APPRAISE specificity for 24-h packed red blood cells of 0 units was 87% (88% for any Shock Index ≥1.4, 88% for initial SBP <110 mmHg, and 90% for any prehospital SBP <90 mmHg). Median APPRAISE hemorrhage notification time was 20 min before arrival at the trauma center. In conclusion, APPRAISE identified bleeding before trauma center arrival. En route, this capability could allow medics to focus on direct patient care rather than the monitor and, via advance radio notification, could expedite hospital interventions for patients with substantial blood loss.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Air Ambulances</subject><subject>Automation</subject><subject>Blood Pressure - physiology</subject><subject>Emergency Medical Services - methods</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Hemorrhage - diagnosis</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Shock - diagnosis</subject><subject>Time Factors</subject><subject>Trauma Centers</subject><subject>Triage - methods</subject><subject>Vital Signs</subject><subject>Young Adult</subject><issn>1073-2322</issn><issn>1540-0514</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1P3DAQhi1UxPc_QMjHXgL-TLK9BVS6qEhUWlqOkROPWRdvvLWdohz475guVKiHzmVGM8-8o3kROqbklJJZdbaYfz0l74OzegvtUSlIQSQVH3JNKl4wztgu2o_xJyFM8Fm1g3aZLEsxq_keemrG5FcqgcbNoNwUbcTe4B82KYcX9n6IOHl8pWFI1kz4m0o2lxHf2bTEi7GLSeVJZs8dgLbDPT4H4wPguY_rPyJNCPa3cp9wgy9BRdtZZ9OEF2nU0yHaNspFOHrNB-j75efbi3lxffPl6qK5LnpOZF2oSvZ0VtdSCy2F6o3mvKtKTVmd36hI7naMdrIvRQdEcmWMqEvVSV2BJsTwA_Rxo7sO_tcIMbUrG3twTg3gx9jSshKMMClERsUG7YOPMYBp18GuVJhaStoX49tsfPuv8Xnt5PXC2K1A_116czoD9QZ49C5BiA9ufITQLkG5tPy_9jN485Af</recordid><startdate>201505</startdate><enddate>201505</enddate><creator>Liu, Jianbo</creator><creator>Khitrov, Maxim Y</creator><creator>Gates, Jonathan D</creator><creator>Odom, Stephen R</creator><creator>Havens, Joaquim M</creator><creator>de Moya, Marc A</creator><creator>Wilkins, Kevin</creator><creator>Wedel, Suzanne K</creator><creator>Kittell, Erin O</creator><creator>Reifman, Jaques</creator><creator>Reisner, Andrew T</creator><general>by the Shock Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201505</creationdate><title>Automated Analysis of Vital Signs to Identify Patients With Substantial Bleeding Before Hospital Arrival: A Feasibility Study</title><author>Liu, Jianbo ; Khitrov, Maxim Y ; Gates, Jonathan D ; Odom, Stephen R ; Havens, Joaquim M ; de Moya, Marc A ; Wilkins, Kevin ; Wedel, Suzanne K ; Kittell, Erin O ; Reifman, Jaques ; Reisner, Andrew T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3058-a75c19885d4d54acfd33b76d128649704d5b21b5c64be053aff486ab5d7ed00f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Air Ambulances</topic><topic>Automation</topic><topic>Blood Pressure - physiology</topic><topic>Emergency Medical Services - methods</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Hemorrhage - diagnosis</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Shock - diagnosis</topic><topic>Time Factors</topic><topic>Trauma Centers</topic><topic>Triage - methods</topic><topic>Vital Signs</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Jianbo</creatorcontrib><creatorcontrib>Khitrov, Maxim Y</creatorcontrib><creatorcontrib>Gates, Jonathan D</creatorcontrib><creatorcontrib>Odom, Stephen R</creatorcontrib><creatorcontrib>Havens, Joaquim M</creatorcontrib><creatorcontrib>de Moya, Marc A</creatorcontrib><creatorcontrib>Wilkins, Kevin</creatorcontrib><creatorcontrib>Wedel, Suzanne K</creatorcontrib><creatorcontrib>Kittell, Erin O</creatorcontrib><creatorcontrib>Reifman, Jaques</creatorcontrib><creatorcontrib>Reisner, Andrew T</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Shock (Augusta, Ga.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Jianbo</au><au>Khitrov, Maxim Y</au><au>Gates, Jonathan D</au><au>Odom, Stephen R</au><au>Havens, Joaquim M</au><au>de Moya, Marc A</au><au>Wilkins, Kevin</au><au>Wedel, Suzanne K</au><au>Kittell, Erin O</au><au>Reifman, Jaques</au><au>Reisner, Andrew T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Automated Analysis of Vital Signs to Identify Patients With Substantial Bleeding Before Hospital Arrival: A Feasibility Study</atitle><jtitle>Shock (Augusta, Ga.)</jtitle><addtitle>Shock</addtitle><date>2015-05</date><risdate>2015</risdate><volume>43</volume><issue>5</issue><spage>429</spage><epage>436</epage><pages>429-436</pages><issn>1073-2322</issn><eissn>1540-0514</eissn><abstract>ABSTRACTTrauma outcomes are improved by protocols for substantial bleeding, typically activated after physician evaluation at a hospital. Previous analysis suggested that prehospital vital signs contained patterns indicating the presence or absence of substantial bleeding. In an observational study of adults (aged ≥18 years) transported to level I trauma centers by helicopter, we investigated the diagnostic performance of the Automated Processing of the Physiological Registry for Assessment of Injury Severity (APPRAISE) system, a computational platform for real-time analysis of vital signs, for identification of substantial bleeding in trauma patients with explicitly hemorrhagic injuries. We studied 209 subjects prospectively and 646 retrospectively. In our multivariate analysis, prospective performance was not significantly different from retrospective. The APPRAISE system was 76% sensitive for 24-h packed red blood cells of 9 or more units (95% confidence interval, 59% – 89%) and significantly more sensitive (P < 0.05) than any prehospital Shock Index of 1.4 or higher; sensitivity, 59%; initial systolic blood pressure (SBP) less than 110 mmHg, 50%; and any prehospital SBP less than 90 mmHg, 50%. The APPRAISE specificity for 24-h packed red blood cells of 0 units was 87% (88% for any Shock Index ≥1.4, 88% for initial SBP <110 mmHg, and 90% for any prehospital SBP <90 mmHg). Median APPRAISE hemorrhage notification time was 20 min before arrival at the trauma center. In conclusion, APPRAISE identified bleeding before trauma center arrival. En route, this capability could allow medics to focus on direct patient care rather than the monitor and, via advance radio notification, could expedite hospital interventions for patients with substantial blood loss.</abstract><cop>United States</cop><pub>by the Shock Society</pub><pmid>25664983</pmid><doi>10.1097/SHK.0000000000000328</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1073-2322 |
| ispartof | Shock (Augusta, Ga.), 2015-05, Vol.43 (5), p.429-436 |
| issn | 1073-2322 1540-0514 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1674202544 |
| source | Journals@Ovid Ovid Autoload; MEDLINE; Journals@Ovid LWW Legacy Archive; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Adult Aged Air Ambulances Automation Blood Pressure - physiology Emergency Medical Services - methods Feasibility Studies Female Hemorrhage - diagnosis Humans Injury Severity Score Male Middle Aged Multivariate Analysis Prospective Studies Retrospective Studies Shock - diagnosis Time Factors Trauma Centers Triage - methods Vital Signs Young Adult |
| title | Automated Analysis of Vital Signs to Identify Patients With Substantial Bleeding Before Hospital Arrival: A Feasibility Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T04%3A12%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Automated%20Analysis%20of%20Vital%20Signs%20to%20Identify%20Patients%20With%20Substantial%20Bleeding%20Before%20Hospital%20Arrival:%20A%20Feasibility%20Study&rft.jtitle=Shock%20(Augusta,%20Ga.)&rft.au=Liu,%20Jianbo&rft.date=2015-05&rft.volume=43&rft.issue=5&rft.spage=429&rft.epage=436&rft.pages=429-436&rft.issn=1073-2322&rft.eissn=1540-0514&rft_id=info:doi/10.1097/SHK.0000000000000328&rft_dat=%3Cproquest_cross%3E1674202544%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1674202544&rft_id=info:pmid/25664983&rfr_iscdi=true |