Accession Number:

ADA620510

Title:

Automated Analysis of Vital Signs to Identify Patients with Substantial Bleeding before Hospital Arrival: A Feasibility Study

Descriptive Note:

Journal article

Corporate Author:

ARMY MEDICAL RESEARCH AND MATERIEL COMMAND FORT DETRICK MD TELEMEDICINE AND ADVANCED TECH RESEARCH CENTER

Report Date:

2015-05-01

Pagination or Media Count:

10.0

Abstract:

Trauma 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 greater than or equal to 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 less than 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 greater than or equal to 1.4, 88 for initial SBP less than 110 mmHg, and 90 for any prehospital SBP less than 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.

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research
  • Human Factors Engineering and Man Machine Systems

Distribution Statement:

APPROVED FOR PUBLIC RELEASE