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...

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Bibliographic Details
Published in:Shock (Augusta, Ga.) Ga.), 2015-05, Vol.43 (5), p.429-436
Main Authors: 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
Format: Article
Language:English
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
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Summary: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
ISSN:1073-2322
1540-0514
DOI:10.1097/SHK.0000000000000328