Improving Patient Safety in Subarachnoid Hemorrhage Using Transcranial Doppler (TCD) Simulation for Bedside Diagnosis of Cerebral Vasospasm

这项研究的目的是提高动脉瘤患者的安全性。 改善蛛网膜下腔出血(ASAH)患者接受推荐经颅手术的途径 多普勒(TCD)监测脑血管痉挛，这是一种影响30-70%ASAH的并发症 并导致近一半的患者死亡。其他诊断模式不适用于序列 由于费用、辐射暴露和后勤而进行的监测，而TCD可以在 病人的床边。TCD被5个专业协会推荐用于脑部监测 然而，血管痉挛在全国范围内仍未得到充分利用。我们解决的问题是缺乏 培训提供者：只有82个实验室获得了社会间认证 委托(IAC)血管测试执行TCD。 我们提出了一种既可用于培训又可用于能力测试的TCD模拟器。我们的 基本原理是，培训更多的提供者并帮助他们保持技能将提高患者的耐心 使用这一推荐的诊断程序；研究表明，超声模拟器可以 满足这些需求。为了开发建议的模拟器，我们将利用原型TCD 目前正在开发的模拟器(MH115883)，并对其性能进行了测试。 目标1：我们将在年完成用于培训和技能评估的模拟器的开发 对脑血管痉挛进行经颅多普勒检查。将创建一个包含24个案例的案例库 反映一系列疾病严重程度的病例，每个病例都是根据实际患者数据准备的。我们会 通过比较测量的血流速度验证模拟的准确性 模拟器波形与3D模型中的真实速度。我们将验证模拟器的 通过比较模拟器上采集的频谱多普勒波形与患者的临床真实性 由专业声学家记录的波形。 目标2：我们将创建一门课程，用于教学脑血管痉挛的TCD检查和 实施基于系统激励和测量速度的技能衡量标准。我们会 评估课程的有效性和技能指标的有效性。 目的#3：我们将通过将受训人员随机分配到模拟器来验证模拟器的临床有效性。 TCD检查的基础培训与标准培训及培训后技能比较 治疗脑血管痉挛。 医疗保健效益：拟议的研究将通过改善 经颅多普勒诊断脑血管痉挛的循证应用 发病率和死亡率。

The goal of this research is to improve the safety of patients who suffer aneurysmal subarachnoid hemorrhage (aSAH) by improving their access to recommended transcranial Doppler (TCD) monitoring for cerebral vasospasm, a complication that affects 30-70% of aSAH patients and leads to death in nearly half. Other diagnostic modalities are impractical for serial monitoring due to expense, radiation exposure and logistics whereas TCD can be performed at the patient’s bedside. TCD is recommended by 5 professional societies for monitoring cerebral vasospasm yet is grossly underused nationally. The problem we address is the scarcity of trained providers: there just 82 laboratories accreditated by the Intersocietal Accreditation Commission (IAC) Vascular Testing to perform TCD. We propose a TCD simulator that can be applied for both training and competency testing. Our rationale is that training more providers and helping them to maintain skill will improve patient access to this recommended diagnostic procedure; studies show that ultrasound simulators can meet these needs. To develop the proposed simulator, we will leverage a prototype TCD simulator that we are currently developing (MH115883) and test its performance. Aim #1: We will complete the development of a simulator for training and skill assessment in performing TCD examination for cerebral vasospasm. A Case Library will be created with 24 cases reflecting a range of disease severity, each prepared from actual patient data. We will verify the accuracy of the simulation by comparing the blood flow velocity measured from the simulator waveforms with the true velocities in the 3D models. We will verify the simulator’s clinical realism by comparing spectral Doppler waveforms captured on the simulator with patient waveforms recorded by expert sonologists. Aim #2: We will create a curriculum for teaching TCD examination for cerebral vasospasm and implement metrics of skill based on systematic insonation and the velocities measured. We will assess the efficacy of the curriculum and the validity of the skill metrics. Aim #3: We will verify the clinical validity of the simulator by randomizing trainees to simulator- based vs. standard training and comparing the post-training skill in performing TCD examination for cerebral vasospasm. HEALTH CARE BENEFIT: The proposed research will improve patient safety by improved, evidence-based utilization of TCD to diagnose cerebral vasospasm, eventually reducing morbidity and mortality.