MANUAL VITAL SIGNS RELIABLY PREDICT NEED FOR LIFE SAVING INTERVENTIONS IN TRAUMA PATIENTS

Trauma patients with “compensated” internal hemorrhage may not be identified with standard medical monitors until signs of shock appear, at which point it may be difficult or too late to pursue life-saving interventions. We tested the hypothesis that a novel machine-learning model called the compensatory reserve index (CRI) could differentiate tolerance to acute volume loss of individuals well in advance of changes in stroke volume (SV) or standard vital signs. Two hundred one healthy humans underwent progressive lower body negative pressure (LBNP) until the onset of hemodynamic instability (decompensation). Continuously measured photoplethysmogram signals were used to estimate SV and develop a model for estimating CRI. Validation of the CRI was tested on 101 subjects who were classified into two groups: low tolerance (LT; n = 33) and high tolerance (HT; n = 68) to LBNP (mean LBNP time: LT = 16.23 min vs. HT = 25.86 min). On an arbitrary scale of 1 to 0, the LT group CRI reached 0.6 at an average time of 5.27 ± 1.18 (95% confidence interval) min followed by 0.3 at 11.39 ± 1.14 min. In comparison, the HT group reached CRI of 0.6 at 7.62 ± 0.94 min followed by 0.3 at 15.35 ± 1.03 min. Changes in heart rate, blood pressure, and SV did not differentiate HT from LT groups. Machine modeling of the photoplethysmogram response to reduced central blood volume can accurately trend individual-specific progression to hemodynamic decompensation. These findings foretell early identification of blood loss, anticipating hemodynamic instability, and timely application of life-saving interventions.

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Development of a heart rate variability and complexity model in predicting the need for life-saving interventions amongst trauma patients

Burns & Trauma ◽

10.1186/s41038-019-0147-2 ◽

2019 ◽

Vol 7 ◽

Author(s):

Aravin Kumar ◽

Nan Liu ◽

Zhi Xiong Koh ◽

Jayne Jie Yi Chiang ◽

Yuda Soh ◽

...

Keyword(s):

Emergency Department ◽

Heart Rate ◽

Heart Rate Variability ◽

Vital Signs ◽

Fluctuation Analysis ◽

Trauma Patients ◽

Ecg Analysis ◽

Patient Disposition ◽

Life Saving ◽

Trauma Scores

Abstract Background Triage trauma scores are utilised to determine patient disposition, interventions and prognostication in the care of trauma patients. Heart rate variability (HRV) and heart rate complexity (HRC) reflect the autonomic nervous system and are derived from electrocardiogram (ECG) analysis. In this study, we aimed to develop a model incorporating HRV and HRC, to predict the need for life-saving interventions (LSI) in trauma patients, within 24 h of emergency department presentation. Methods We included adult trauma patients (≥ 18 years of age) presenting at the emergency department of Singapore General Hospital between October 2014 and October 2015. We excluded patients who had non-sinus rhythms and larger proportions of artefacts and/or ectopics in ECG analysis. We obtained patient demographics, laboratory results, vital signs and outcomes from electronic health records. We conducted univariate and multivariate analyses for predictive model building. Results Two hundred and twenty-five patients met inclusion criteria, in which 49 patients required LSIs. The LSI group had a higher proportion of deaths (10, 20.41% vs 1, 0.57%, p < 0.001). In the LSI group, the mean of detrended fluctuation analysis (DFA)-α1 (1.24 vs 1.12, p = 0.045) and the median of DFA-α2 (1.09 vs 1.00, p = 0.027) were significantly higher. Multivariate stepwise logistic regression analysis determined that a lower Glasgow Coma Scale, a higher DFA-α1 and higher DFA-α2 were independent predictors of requiring LSIs. The area under the curve (AUC) for our model (0.75, 95% confidence interval, 0.66–0.83) was higher than other scoring systems and selected vital signs. Conclusions An HRV/HRC model outperforms other triage trauma scores and selected vital signs in predicting the need for LSIs but needs to be validated in larger patient populations.

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Manual Vital Signs Reliably Predict Need for Life-Saving Interventions in Trauma Patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000188125.44129.7c ◽

2005 ◽

Vol 59 (4) ◽

pp. 821-829 ◽

Cited By ~ 80

Author(s):

John B. Holcomb ◽

Jose Salinas ◽

John M. McManus ◽

Charles C. Miller ◽

William H. Cooke ◽

...

Keyword(s):

Vital Signs ◽

Trauma Patients ◽

Life Saving

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Associations of On-arrival Vital Signs with 24-hour In-hospital Mortality in Adult Trauma Patients Admitted to Four Public University Hospitals in Urban India: A Prospective Multi-Centre Cohort Study

Injury ◽

10.1016/j.injury.2021.02.075 ◽

2021 ◽

Author(s):

Bhakti Sarang ◽

Prashant Bhandarkar ◽

Nakul Raykar ◽

Gerard M O Reilly ◽

Kapil Dev Soni ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Vital Signs ◽

Public University ◽

Trauma Patients ◽

University Hospitals ◽

Urban India

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An Endovascular Surgery Experience in Far-Forward Military Healthcare—A Case Series

Military Medicine ◽

10.1093/milmed/usaa219 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. 2183-2188

Author(s):

Daniel J Coughlin ◽

Jason H Boulter ◽

Charles A Miller ◽

Brian P Curry ◽

Jacob Glaser ◽

...

Keyword(s):

Case Series ◽

Interventional Neuroradiology ◽

Military Hospital ◽

Lingual Artery ◽

Trauma Patients ◽

Military Hospitals ◽

Life Saving ◽

Military Healthcare ◽

Internal Iliac ◽

First World

Abstract Summary Introduction The advancement of interventional neuroradiology has drastically altered the treatment of stroke and trauma patients. These advancements in first-world hospitals, however, have rarely reached far forward military hospitals due to limitations in expertise and equipment. In an established role III military hospital though, these life-saving procedures can become an important tool in trauma care. Materials and Methods We report a retrospective series of far-forward endovascular cases performed by 2 deployed dual-trained neurosurgeons at the role III hospital in Kandahar, Afghanistan during 2013 and 2017 as part of Operations Resolute Support and Enduring Freedom. Results A total of 15 patients were identified with ages ranging from 5 to 42 years old. Cases included 13 diagnostic cerebral angiograms, 2 extremity angiograms and interventions, 1 aortogram and pelvic angiogram, 1 bilateral embolization of internal iliac arteries, 1 lingual artery embolization, 1 administration of intra-arterial thrombolytic, and 2 mechanical thrombectomies for acute ischemic stroke. There were no complications from the procedures. Both embolizations resulted in hemorrhage control, and 1 of 2 stroke interventions resulted in the improvement of the NIH stroke scale. Conclusions Interventional neuroradiology can fill an important role in military far forward care as these providers can treat both traumatic and atraumatic cerebral and extracranial vascular injuries. In addition, knowledge and skill with vascular access and general interventional radiology principles can be used to aid in other lifesaving interventions. As interventional equipment becomes more available and portable, this relatively young specialty can alter the treatment for servicemen and women who are injured downrange.

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Abstract 18150: Prediction of Imminent Deterioration of Children after Stage I Palliation Using Real-Time Processing of Physiological Data

Circulation ◽

10.1161/circ.130.suppl_2.18150 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Craig G Rusin ◽

Sebastian I Acosta ◽

Eric L Vu ◽

Risa B Myers ◽

Kenneth M Brady ◽

...

Keyword(s):

Early Life ◽

Physiological State ◽

Vital Signs ◽

Clinical Deterioration ◽

Physiological Data ◽

Real Time Processing ◽

Life Saving ◽

St Segment ◽

The Hours ◽

Roc Area

Patients after stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS) and related lesions are at risk of life threatening deterioration resulting in shock, cardiac arrest, & hypoxemia. We hypothesize that these sudden deteriorations may be forecast by subtle, previously unidentified changes in cardiorespiratory dynamics. Identification of these precursors may provide an opportunity for early, life-saving intervention. We created complete high-resolution physiological recordings for all patients who had a primary admission of S1P after Jan. 1, 2013. We used the SickbayTM system (Medical Informatics Corp, Houston, TX) to collect high frequency physiological waveforms including EKG, ABP, LAP, SpO2 and Chest Impedance (60Hz - 240Hz), as well as HR, RR, Temp. and ST segment vital signs (0.5 Hz) during the patient’s interstage hospitalization. A logistic regression model was constructed to discriminate between physiological characteristics observed in the hours prior to deterioration from the characteristics observed >24 hours prior to or >96 hours after a clinical deterioration. Model validation was done using a standard bagging approach with a REPtree classifier and 10 fold cross validation. Twenty five patients were included in the study. Of these, 15 (60%) were found to have one or more deterioration events (arrest, CPR, unplanned intubation), with 24 total events observed during the interstage period. Characteristics associated with imminent deterioration were low SpO2 and depressed ST segment. Changes in physiological dynamics could be detected 1-2 hours before overt deterioration occurs (ROC area = 0.89) (Figure 1). This altered physiological state remains for ~96 hours after deterioration. In conclusion, it is possible to identify clinical deterioration in HLHS patients during their interstage period ~1-2 hours before overt deterioration occurs, providing an opportunity for early, life-saving intervention to be administered.

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