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Photo courtesy of UAB Hospital
A computerized system that analyzes vital signs can help healthcare professionals more accurately diagnose trauma patients with life-threatening bleeding, according to research published in Shock.
The system, known as APPRAISE, simultaneously analyzes blood pressure, heart rate, and breathing patterns during emergency transport.
And investigators found that APPRAISE accurately detected most cases of life-threatening bleeding.
“Providing faster care to patients who are bleeding to death saves lives,” said study author Andrew Reisner, MD, of Massachusetts General Hospital in Boston.
“While the clinical information that ambulance crews call in to trauma centers was sufficient to determine the presence of a life-threatening hemorrhage in about half the patients we studied, many other patients were in a ‘gray area’ and may or may not have been at risk of bleeding to death.”
“Our study demonstrated that automated analysis of patients’ vital signs during prehospital transport was significantly better at discriminating between patients who did and did not have life-threatening hemorrhage.”
The APPRAISE system incorporates software based on statistical techniques currently used in stock market trading and manufacturing to determine whether particular data points represent real problems and not random fluctuations.
The system uses an ultracompact personal computer to analyze data gathered by a standard patient monitor used in emergency transport vehicles.
For this study, the system was installed in 2 MedFlight helicopters and collected data on more than 200 trauma patients transported to participating Boston hospitals from February 2010 to December 2012. So that patients’ care was not affected by a still-unproven system, the APPRAISE system’s analysis was not provided to MedFlight crews.
The researchers also analyzed information from a 2005 study of vital sign data gathered manually by a Houston-based air ambulance system.
The team found the APPRAISE system could identify, with 76% sensitivity, patients who needed 9 or more units of packed red blood cells within 24 hours.
This was significantly more sensitive (P<0.05) than any prehospital Shock Index of 1.4 or higher (59%), initial systolic blood pressure less than 110 mmHg (50%), and any prehospital systolic blood pressure less than 90 mmHg (50%).
However, there was no signficant difference between the different measures with regard to specificity for identifying patients who did not need a blood transfusion within 24 hours.
Specificity was 87% for APPRAISE, 88% for any Shock Index of 1.4 or higher, 88% for initial systolic blood pressure less than 110 mmHg, and 90% for any prehospital systolic blood pressure less than 90 mmHg.
Notifications provided by APPRAISE would have been available within 10 minutes of initial monitoring and a median of 20 minutes before patients arrived at the trauma centers.
“The fact that decisions to proceed with surgery or to replenish lost blood often occur only after patients’ arrival means there are delays—sometimes brief but sometimes prolonged—in initiating such life-saving interventions,” Dr Reisner said.
“We are now working on a follow-up study to use this system in actual trauma care and will be measuring whether it truly leads to faster treatment of life-threatening hemorrhage and better patient outcomes. This approach could also be helpful for patients transported by ground ambulance and for hospitalized patients at risk of unexpected hemorrhage, such as during recovery from major surgery.” 
Photo courtesy of UAB Hospital
A computerized system that analyzes vital signs can help healthcare professionals more accurately diagnose trauma patients with life-threatening bleeding, according to research published in Shock.
The system, known as APPRAISE, simultaneously analyzes blood pressure, heart rate, and breathing patterns during emergency transport.
And investigators found that APPRAISE accurately detected most cases of life-threatening bleeding.
“Providing faster care to patients who are bleeding to death saves lives,” said study author Andrew Reisner, MD, of Massachusetts General Hospital in Boston.
“While the clinical information that ambulance crews call in to trauma centers was sufficient to determine the presence of a life-threatening hemorrhage in about half the patients we studied, many other patients were in a ‘gray area’ and may or may not have been at risk of bleeding to death.”
“Our study demonstrated that automated analysis of patients’ vital signs during prehospital transport was significantly better at discriminating between patients who did and did not have life-threatening hemorrhage.”
The APPRAISE system incorporates software based on statistical techniques currently used in stock market trading and manufacturing to determine whether particular data points represent real problems and not random fluctuations.
The system uses an ultracompact personal computer to analyze data gathered by a standard patient monitor used in emergency transport vehicles.
For this study, the system was installed in 2 MedFlight helicopters and collected data on more than 200 trauma patients transported to participating Boston hospitals from February 2010 to December 2012. So that patients’ care was not affected by a still-unproven system, the APPRAISE system’s analysis was not provided to MedFlight crews.
The researchers also analyzed information from a 2005 study of vital sign data gathered manually by a Houston-based air ambulance system.
The team found the APPRAISE system could identify, with 76% sensitivity, patients who needed 9 or more units of packed red blood cells within 24 hours.
This was significantly more sensitive (P<0.05) than any prehospital Shock Index of 1.4 or higher (59%), initial systolic blood pressure less than 110 mmHg (50%), and any prehospital systolic blood pressure less than 90 mmHg (50%).
However, there was no signficant difference between the different measures with regard to specificity for identifying patients who did not need a blood transfusion within 24 hours.
Specificity was 87% for APPRAISE, 88% for any Shock Index of 1.4 or higher, 88% for initial systolic blood pressure less than 110 mmHg, and 90% for any prehospital systolic blood pressure less than 90 mmHg.
Notifications provided by APPRAISE would have been available within 10 minutes of initial monitoring and a median of 20 minutes before patients arrived at the trauma centers.
“The fact that decisions to proceed with surgery or to replenish lost blood often occur only after patients’ arrival means there are delays—sometimes brief but sometimes prolonged—in initiating such life-saving interventions,” Dr Reisner said.
“We are now working on a follow-up study to use this system in actual trauma care and will be measuring whether it truly leads to faster treatment of life-threatening hemorrhage and better patient outcomes. This approach could also be helpful for patients transported by ground ambulance and for hospitalized patients at risk of unexpected hemorrhage, such as during recovery from major surgery.”
Photo courtesy of UAB Hospital
A computerized system that analyzes vital signs can help healthcare professionals more accurately diagnose trauma patients with life-threatening bleeding, according to research published in Shock.
The system, known as APPRAISE, simultaneously analyzes blood pressure, heart rate, and breathing patterns during emergency transport.
And investigators found that APPRAISE accurately detected most cases of life-threatening bleeding.
“Providing faster care to patients who are bleeding to death saves lives,” said study author Andrew Reisner, MD, of Massachusetts General Hospital in Boston.
“While the clinical information that ambulance crews call in to trauma centers was sufficient to determine the presence of a life-threatening hemorrhage in about half the patients we studied, many other patients were in a ‘gray area’ and may or may not have been at risk of bleeding to death.”
“Our study demonstrated that automated analysis of patients’ vital signs during prehospital transport was significantly better at discriminating between patients who did and did not have life-threatening hemorrhage.”
The APPRAISE system incorporates software based on statistical techniques currently used in stock market trading and manufacturing to determine whether particular data points represent real problems and not random fluctuations.
The system uses an ultracompact personal computer to analyze data gathered by a standard patient monitor used in emergency transport vehicles.
For this study, the system was installed in 2 MedFlight helicopters and collected data on more than 200 trauma patients transported to participating Boston hospitals from February 2010 to December 2012. So that patients’ care was not affected by a still-unproven system, the APPRAISE system’s analysis was not provided to MedFlight crews.
The researchers also analyzed information from a 2005 study of vital sign data gathered manually by a Houston-based air ambulance system.
The team found the APPRAISE system could identify, with 76% sensitivity, patients who needed 9 or more units of packed red blood cells within 24 hours.
This was significantly more sensitive (P<0.05) than any prehospital Shock Index of 1.4 or higher (59%), initial systolic blood pressure less than 110 mmHg (50%), and any prehospital systolic blood pressure less than 90 mmHg (50%).
However, there was no signficant difference between the different measures with regard to specificity for identifying patients who did not need a blood transfusion within 24 hours.
Specificity was 87% for APPRAISE, 88% for any Shock Index of 1.4 or higher, 88% for initial systolic blood pressure less than 110 mmHg, and 90% for any prehospital systolic blood pressure less than 90 mmHg.
Notifications provided by APPRAISE would have been available within 10 minutes of initial monitoring and a median of 20 minutes before patients arrived at the trauma centers.
“The fact that decisions to proceed with surgery or to replenish lost blood often occur only after patients’ arrival means there are delays—sometimes brief but sometimes prolonged—in initiating such life-saving interventions,” Dr Reisner said.
“We are now working on a follow-up study to use this system in actual trauma care and will be measuring whether it truly leads to faster treatment of life-threatening hemorrhage and better patient outcomes. This approach could also be helpful for patients transported by ground ambulance and for hospitalized patients at risk of unexpected hemorrhage, such as during recovery from major surgery.”