Mathematical program for outcome prediction and therapeutic support for trauma beginning within 1 hr of admission: A preliminary report

OBJECTIVES:The aims were a) to noninvasively monitor acute emergency trauma patients beginning within 1 hr after admission to the emergency department; b) to prospectively predict outcome; and c) to evaluate the relative effectiveness of various modes of therapy. DESIGN:Prospective outcome prediction study using a mathematical search and display model based on noninvasive hemodynamic monitoring. SETTING:A level I trauma service in a large university-run inner-city public hospital. PATIENTS:We studied 185 consecutively noninvasively monitored emergency patients. INTERVENTIONS:We noninvasively monitored cardiac index, mean arterial blood pressure, heart rate, pulse oximetry, and transcutaneous oxygen and carbon dioxide tensions beginning within 1-hr after emergency admission. MEASUREMENTS AND MAIN RESULTS:The cardiac index, pulse oximetry, transcutaneous oxygen tension, transcutaneous carbon dioxide tension, and mean arterial blood pressure were higher in survivors than in nonsurvivors in the initial resuscitation period and at the hemodynamic nadir. Heart rate and transcutaneous carbon dioxide tension were higher in the nonsurvivors. The calculated survival probability in the first hour observation period of survivors averaged 85 ± 14% vs. 69 ± 16% for nonsurvivors (p = .0001). Misclassifications of the series as a whole were 11.3%; after excluding brain death from severe head injury, there were 6.4% misclassifications. A decision support system evaluated the effects of various therapies based on responses of patients with similar clinical-hemodynamic states. CONCLUSION:Noninvasive hemodynamic monitoring and an information system provided a feasible approach to predict outcome early and to evaluate prospectively the efficacy of various therapies.