Sanborn K V, Castro J, Kuroda M, Thys D M
Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, New York, New York 10025, USA.
Anesthesiology. 1996 Nov;85(5):977-87. doi: 10.1097/00000542-199611000-00004.
The use of a computerized anesthesia information management system provides an opportunity to scan case records electronically for deviations from specific limits for physiologic variables. Anesthesia department policy may define such deviations as intraoperative incidents and may require anesthesiologists to report their occurrence. The actual incidence of such events is not known. Neither is the level of compliance with voluntary reporting.
Using automated anesthesia record-keeping with long-term storage, physiologic data were recorded every 15 s from 5,454 patients undergoing noncardiothoracic surgery. Recorded measurements of blood pressure, heart rate, arterial oxygen saturation, and temperature were electronically analyzed for deviations from defined limits. The computer system also was used by anesthesiologists to report voluntarily those deviations as intraoperative incidents. For each electronically detected incident: 1) the complete automated anesthesia record was examined by two senior anesthesiologists who, by consensus, eliminated case records with artifact or in which context suggested that the incident was not clinically relevant, and 2) the anesthesia information management system database was checked for voluntary reporting.
In 473 automated anesthesia records, 494 incidents were found by electronic scanning of 5,454 automated anesthesia records. Sixty intraoperative incidents were eliminated, 25 due to artifact and 35 due to context. When the remaining 434 intraoperative incidents were checked for voluntary reporting, 18 (4.1%) matching voluntary reports were found. All intraoperative incidents that were reported voluntarily also were detected by electronic scanning. Based on a 10% sample, the sensitivity rate of electronic scanning was 97.2% (35/36), and the specificity rate was 98.4% (427/434). Among 413 cases with electronically detected intraoperative incidents, there were 29 deaths (7.0%), whereas there were only 79 deaths (1.6%) among 5,041 cases without incidents (chi 2 = 58.5, P < 0.001).
The use of an anesthesia information management system facilitated analysis of intraoperative physiologic data and identified certain intraoperative incidents with high sensitivity and specificity. A low level of compliance with voluntary reporting of defined intraoperative incidents was found for all anesthesiologists studied. Finally, there was a strong association between intraoperative incidents and in-hospital mortality.
使用计算机化麻醉信息管理系统能够提供机会，以电子方式扫描病例记录，查找生理变量偏离特定限值的情况。麻醉科政策可能将此类偏差定义为术中事件，并可能要求麻醉医生报告其发生情况。此类事件的实际发生率尚不清楚。自愿报告的依从程度也不明确。
通过自动麻醉记录保存和长期存储，每15秒记录5454例非心胸外科手术患者的生理数据。对记录的血压、心率、动脉血氧饱和度和体温测量值进行电子分析，以查找偏离定义限值的情况。麻醉医生还使用计算机系统自愿报告这些偏差为术中事件。对于每例电子检测到的事件：1）两名资深麻醉医生检查完整的自动麻醉记录，他们通过协商一致，排除有伪迹的病例记录或根据背景情况表明该事件与临床无关的病例记录；2）检查麻醉信息管理系统数据库中的自愿报告情况。
在5454份自动麻醉记录中，通过电子扫描在473份记录中发现了494起事件。排除了60起术中事件，25起是由于伪迹，35起是由于背景情况。在检查其余434起术中事件的自愿报告情况时，发现了18份（4.1%）匹配的自愿报告。所有自愿报告的术中事件也通过电子扫描检测到。基于10%的样本，电子扫描的灵敏度为97.2%（35/36），特异度为98.4%（427/434）。在413例有电子检测到术中事件的病例中，有29例死亡（7.0%），而在5041例无事件的病例中仅有79例死亡（1.6%）（卡方检验=58.5，P<0.001）。
使用麻醉信息管理系统有助于分析术中生理数据，并以高灵敏度和特异度识别某些术中事件。在所有研究的麻醉医生中，发现对定义的术中事件自愿报告的依从程度较低。最后，术中事件与院内死亡率之间存在强烈关联。
