Automated System Could Prevent Trauma Exsanguinations

A computerized system that analyzes vital signs during emergency transport can accurately detect most cases of life-threatening bleeding in a fully automated fashion.

Developed by researchers at Massachusetts General Hospital (MGH; Boston, MA, USA), the US Army Medical Research and Materiel Command (USAMRMC; Fort Detrick, MD, USA), air ambulance service Boston MedFlight (MA, USA), and other institutions, the Automated Processing of the Physiological Registry for Assessment of Injury Severity (APPRAISE) system consists of an ultra-compact personal computer networked to a standard patient monitor that collects blood pressure, heart rate, and breathing data.

To investigate whether computerized analysis of data being gathered by the vital signs monitor during transport could identify patients with dangerous bleeding, the researchers used software based on statistical techniques currently used in stock market trading and manufacturing to determine whether particular data points represent real problems, and not random fluctuations. They therefore installed APPRAISE systems in two MedFlight helicopters and collected data on more than 200 trauma patients transported to participating Boston hospitals from February 2010 to December 2012.

The results showed that the pattern-recognition capability provided by the APPRAISE system—which was able to simultaneously combine measures of blood pressure with those of heart rate, breathing and the amount of blood pumped with each heartbeat—successfully identified 75%–80% of patients with life-threatening bleeding, compared with 50% who were identified by standard clinical practice. Notifications provided by the system could thus be available 20–40 minutes before patients arrived at trauma centers. The study was published in the May 2015 issue of Shock.

“Our study demonstrated that automated analysis of patients’ vital signs during prehospital transport was significantly better at discriminating between patients who did and did not have life-threatening hemorrhage,” said senior author Andrew Reisner, MD, of MGH. “Receiving more reliable information before the patient arrives can help hospitals be ready for immediate surgery and replenishment of lost blood, without wasting time and resources on false alarms.”

“This system provides an automated indicator of injury severity, an objective way for clinicians to prioritize care,” added corresponding author Jaques Reifman, PhD, of the USAMRMC. “Care prioritization or triage is a very important problem in military medicine, when there may be more injured casualties than caregivers. In those situations the ability to wisely choose who needs priority care is truly a matter of life and death.”

Related Links:
Massachusetts General Hospital
US Army Medical Research and Materiel Command
Boston MedFlight