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Comparison of Decision Assist and Clinical Judgment of Experts for Prediction of Lifesaving Interventions

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Journal Article

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USAFSAM/ETS Wright-Patterson AFB United States

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Early recognition of hemorrhage during the initial resuscitation of injured patients is associated with improved survival in both civilian and military casualties. We tested a transfusion and lifesaving intervention LSI prediction algorithm in comparison with clinical judgment of expert trauma care providers. We collected 15 min of pulse oximeter photopletysmograph waveforms and extracted features to predict LSIs. We compared this with clinical judgment of LSIs by individual categories of prehospital providers, nurses, and physicians and a combined judgment of all three providers using the Area Under Receiver Operating Curve AUROC. We obtained clinical judgment of need for LSI from 405 expert clinicians in 135 trauma patients. The pulse oximeter algorithm predicted transfusion within 6 h AUROC, 0.92 P 0.003 more accurately than either physicians or prehospital providers and as accurately as nurses AUROC, 0.76 P 0.07. For prediction of surgical procedures, the algorithm was as accurate as the three categories of clinicians. For prediction of fluid bolus, the diagnostic algorithm AUROC, 0.9 was significantly more accurate than prehospital providers AUROC, 0.62 P 0.02 and nurses AUROC, 0.57 P 0.04 and as accurate as physicians AUROC, 0.71 P 0.06.Prediction of intubation by the algorithm AUROC, 0.92 was as accurate as each of the three categories of clinicians. The algorithm was more accurate P 0.03 for blood and fluid prediction than the combined clinical judgment of all three providers but no different from the clinicians in the prediction of surgery P 0.7 or intubation P 0.8. Automated analysis of 15 min of pulse oximeter waveforms predicts the need for LSIs during initial trauma resuscitation as accurately as judgment of expert trauma clinicians. For prediction of emergency transfusion and fluid bolus, pulse oximetry features were more accurate than these experts.

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