Journal
CRITICAL CARE MEDICINE
Volume 39, Issue 5, Pages 1006-1014Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0b013e31820eab8e
Keywords
hypotension; intensive care; physiologic monitoring; electronic medical record; digital signal processing; automatic data processing
Categories
Funding
- National Library of Medicine (Bethesda, MD) [LM 07092]
- U.S. National Institute of Biomedical Imaging and Bioengineering (Bethesda, MD)
- National Institutes of Health (Bethesda, MD) [R01 EB001659]
- Philips Healthcare (An-dover, MA)
- Information and Communication University (Daejeon, Korea)
- National Institutes of Health (Bethesda, MD)
- National Institutes of Health
Ask authors/readers for more resources
Objective: To compare invasive blood pressure measurements recorded using an automated archiving method against clinician-documented values from the same invasive monitor and determine which method of recording blood pressure is more highly associated with the subsequent onset of hypotension. Design: Retrospective comparative analysis. Setting: Intensive care patients in a university hospital. Patients: Mixed medical/surgical patients. Interventions: None. Measurements and Main Results: Using intervals of hemodynamic stability from 2,320 patient records, we retrospectively compared paired sources of invasive blood pressure data: 1) measurements documented by the nursing staff and 2) measurements generated by an automated archiving method that intelligently excludes unreliable (e. g., noisy or excessively damped) blood pressure values. The primary outcome was the occurrence of subsequent consensus hypotension, i.e., hypotension documented jointly by the nursing staff and the automated archive. The automated method could be adjusted to alter its operating characteristics (sensitivity and specificity). At a matched level of specificity (96%), blood pressures from the automated archiving method were more sensitive (28%) for subsequent consensus hypotension vs. the nurse-documented values (21%). Likewise, at a matched level of sensitivity (21%), the values from the automated method were more specific (99%) vs. the nurse-documented values (96%). These significant findings (p < .001) were consistent in a set of sensitivity analyses that employed alternative criteria for patient selection and the clinical outcome definition. Conclusions: During periods of hemodynamic stability in an intensive care unit patient population, clinician-documented blood pressure values were inferior to values from an intelligent automated archiving method as early indicators of hemodynamic instability. Human oversight may not be necessary for creating a valid archive of vital sign data within an electronic medical record. Furthermore, if clinicians do have a tendency to disregard early indications of instability, then an automated archive may be a preferable source of data for so-called early warning systems that identify patients at risk of decompensation. (Crit Care Med 2011; 39:1006-1014)
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available