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
*Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, US Army Medical Research and Materiel Command, Fort Detrick, Maryland; and †Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts; ‡Department of Surgery, Division of Acute Care Surgery, Trauma, and Surgical Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and §Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; ∥Boston MedFlight, Bedford, Massachusetts; and ¶Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Shock. 2015 May;43(5):429-36. doi: 10.1097/SHK.0000000000000328.
Trauma 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 <110 mmHg, and 90% for any prehospital SBP <90 mmHg). Median APPRAISE hemorrhage notification time was 20 min before arrival at the trauma center. In conclusion, APPRAISE identified bleeding before trauma center arrival. En route, this capability could allow medics to focus on direct patient care rather than the monitor and, via advance radio notification, could expedite hospital interventions for patients with substantial blood loss.
针对严重出血的方案可改善创伤治疗效果，此类方案通常在医院医生评估后启动。先前的分析表明，院前生命体征包含提示严重出血存在与否的模式。在一项对通过直升机转运至一级创伤中心的成年人（年龄≥18岁）的观察性研究中，我们调查了用于评估损伤严重程度的生理登记自动处理系统（APPRAISE）——一个用于实时分析生命体征的计算平台——对明确有出血性损伤的创伤患者中严重出血的诊断性能。我们前瞻性地研究了209名受试者，回顾性地研究了646名受试者。在我们的多变量分析中，前瞻性表现与回顾性表现无显著差异。APPRAISE系统对24小时内输注9个或更多单位浓缩红细胞的敏感性为76%（95%置信区间，59% - 89%），且显著高于任何院前休克指数≥1.4时的敏感性（59%）；初始收缩压（SBP）低于110 mmHg时的敏感性为50%；任何院前SBP低于90 mmHg时的敏感性为50%。APPRAISE系统对24小时内输注0单位浓缩红细胞的特异性为87%（任何休克指数≥1.4时为88%，初始SBP <110 mmHg时为88%，任何院前SBP <90 mmHg时为90%）。APPRAISE系统发出出血通知的中位时间是在抵达创伤中心前20分钟。总之，APPRAISE系统能在创伤中心到达前识别出血情况。在转运途中，这一功能可使医护人员专注于直接的患者护理而非监测，并通过提前无线电通知，加快对大量失血患者的医院干预。
