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

使用经颅多普勒 (TCD) 模拟进行脑血管痉挛的床边诊断，提高蛛网膜下腔出血患者的安全性

• 批准号: 10214676
• 负责人: Deepak Sharma
• 金额: $ 38.38万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10214676
• 关键词: Improving; Patient; Safety; Subarachnoid; Hemorrhage

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.

这项研究的目的是提高患有精神分裂症的患者的安全性。 蛛网膜下腔出血（aSAH），通过改善他们的访问推荐的经颅 多普勒（TCD）监测脑血管痉挛，一种影响30-70% aSAH的并发症 患者死亡率近一半。其他诊断方式对于连续性 由于费用、辐射暴露和后勤原因， 病人的床边。TCD被5个专业协会推荐用于监测脑 血管痉挛在全国范围内的应用严重不足。我们要解决的问题是 经过培训的供应商：只有82个实验室获得了国际社会认证 委托（IAC）血管测试进行TCD。 我们提出了一个TCD模拟器，可以应用于培训和能力测试。我们 理由是培训更多的提供者并帮助他们保持技能将改善患者 获得此推荐的诊断程序;研究表明，超声模拟器可以 满足这些需求。为了开发拟议的模拟器，我们将利用原型TCD 模拟器，我们目前正在开发（MH 115883），并测试其性能。 目标#1：我们将完成培训和技能评估模拟器的开发， 经颅多普勒检查脑血管痉挛。将创建一个案例库， 反映疾病严重程度范围的病例，每个病例均根据实际患者数据编制。我们将 通过比较从测量的血流速度来验证模拟的准确性。 模拟器波形与3D模型中的真实速度。我们将验证模拟器的 通过比较模拟器上捕获的频谱多普勒波形与患者的临床真实性 由专业声效学家记录的波形。 目标#2：我们将创建一个用于教授脑血管痉挛TCD检查的课程， 实施基于系统性声波作用和测量的速度的技能度量。我们将 评估课程的有效性和技能指标的有效性。 目标#3：我们将通过将受训者随机分配到模拟器来验证模拟器的临床有效性- 基础培训与标准培训，并比较培训后进行TCD检查的技能 治疗脑血管痉挛 医疗保健效益：拟议的研究将通过改善， 循证利用TCD诊断脑血管痉挛，最终减少 发病率和死亡率。