Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
Crit Care Med. 2011 May;39(5):1006-14. doi: 10.1097/CCM.0b013e31820eab8e.
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.
Retrospective comparative analysis.
Intensive care patients in a university hospital.
Mixed medical/surgical patients.
None.
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.
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.
比较使用自动归档方法记录的有创血压测量值与同一有创监测仪记录的临床医生记录的值，并确定哪种血压记录方法与随后发生的低血压更相关。
回顾性比较分析。
大学医院的重症监护病房患者。
混合内科/外科患者。
无。
使用来自 2320 份患者记录的血流动力学稳定间隔，我们回顾性比较了有创血压数据的配对来源：1）护理人员记录的测量值和 2）由智能排除不可靠（例如，嘈杂或过度衰减）血压值的自动归档方法生成的测量值。主要结果是随后发生的“共识”低血压的发生，即护理人员和自动档案共同记录的低血压。可以调整自动方法来改变其操作特性（敏感性和特异性）。在匹配特异性水平（96%）下，自动归档方法的血压值对随后的共识低血压更敏感（28%），而护士记录的值（21%）。同样，在匹配的敏感性水平（21%）下，自动方法的值更特异（99%），而护士记录的值（96%）。这些重要发现（p<.001）在一组采用替代患者选择和临床结果定义的敏感性分析中是一致的。
在重症监护病房患者人群的血流动力学稳定期间，临床医生记录的血压值不如智能自动归档方法作为血流动力学不稳定的早期指标。在电子病历中创建有效的生命体征数据档案可能不需要人为监督。此外，如果临床医生确实倾向于忽略不稳定的早期迹象，那么自动档案可能是识别有失代偿风险患者的所谓早期预警系统的首选数据源。
