Opioid overdose detection using smartphones
Opioid overdose detection using smartphones
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DOI：
10.1126/scitranslmed.aau8914
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发表时间：
2019-01-09
影响因子：
17.1
通讯作者：
Sunshine, Jacob E.
中科院分区：
文献类型：
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作者：
Nandakumar, Rajalakshmi;Gollakota, Shyamnath;Sunshine, Jacob E.
早期发现和快速干预可防止阿片类药物过量死亡。在高剂量下，阿片类药物（特别是芬太尼）可导致呼吸迅速停止（呼吸暂停）、低氧血症/高碳呼吸衰竭和死亡，这是人们通常因无意中过量服用阿片类药物而死亡的生理顺序。我们提出了在智能手机上运行的算法，可以不显眼地检测阿片类药物过量事件及其前体。我们的概念验证非接触式系统将手机转换为短距离主动声纳，使用频移来识别与急性阿片类药物毒性相关的呼吸抑制、呼吸暂停和大运动运动。我们在两个环境中开发算法并进行测试：(i)经批准的监督注射设施（SIF），人们在那里自行注射非法阿片类药物；（ii）手术室（OR），我们在那里使用常规全身麻醉诱导模拟阿片类药物引起的快速过量事件。在SIF （n = 209）中，我们的系统识别注射后阿片类药物诱导的中枢呼吸暂停的灵敏度为96%，特异性为98%，识别呼吸抑制的灵敏度为87%，特异性为89%。这两个关键事件通常发生在致命的阿片类药物过量之前。在手术室里，我们的算法识别了20个模拟服药过量事件中的19个。鉴于急性阿片类药物毒性的可靠可逆性，智能手机支持的过量检测加上向配备纳洛酮的朋友和家人或紧急医疗服务（EMS）发出警报的能力，可能成为一种低障碍、减少危害的干预措施。
Early detection and rapid intervention can prevent death from opioid overdose. At high doses, opioids (particularly fentanyl) can cause rapid cessation of breathing (apnea), hypoxemic/hypercarbic respiratory failure, and death, the physiologic sequence by which people commonly succumb from unintentional opioid overdose. We present algorithms that run on smartphones and unobtrusively detect opioid overdose events and their precursors. Our proof-of- concept contactless system converts the phone into a short-range active sonar using frequency shifts to identify respiratory depression, apnea, and gross motor movements associated with acute opioid toxicity. We develop algorithms and perform testing in two environments: (i) an approved supervised injection facility (SIF), where people self-inject illicit opioids, and (ii) the operating room (OR), where we simulate rapid, opioid-induced overdose events using routine induction of general anesthesia. In the SIF (n = 209), our system identified postinjection, opioid-induced central apnea with 96% sensitivity and 98% specificity and identified respiratory depression with 87% sensitivity and 89% specificity. These two key events commonly precede fatal opioid overdose. In the OR, our algorithm identified 19 of 20 simulated overdose events. Given the reliable reversibility of acute opioid toxicity, smartphone-enabled overdose detection coupled with the ability to alert naloxone-equipped friends and family or emergency medical services (EMS) could hold potential as a low-barrier, harm reduction intervention.