Validation Study of an Automated Electronic Acute Lung Injury Screening Tool
Validation Study of an Automated Electronic Acute Lung Injury Screening Tool
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DOI：
10.1197/jamia.m3120
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发表时间：
2009-07-01
影响因子：
6.4
通讯作者：
Fuchs, Barry D.
中科院分区：
文献类型：
--
作者：
Azzam, Helen C.;Khalsa, Satjeet S.;Fuchs, Barry D.
目的：作者设计了一种自动化电子系统，该系统整合了来自多个医院信息系统的数据，以筛选机械通气患者的急性肺损伤（ALI）。作者评估了该系统在诊断严重创伤患者中的ALI的准确性，但排除了充血性心力衰竭（CHF）患者。设计：单中心验证研究。通过自动电子系统前瞻性筛选一组重症监护室（ICU）严重创伤患者（不包括CHF患者）的动脉血气（ABG）数据和胸片（CXR）报告，以确定是否存在需要插管的ALI。将该系统与通过两名设盲医生审查员的共识建立的参考标准进行比较，这两名医生审查员使用所有可用的ABG数据和CXR图像独立筛选相同人群的ALI。通过（1）测量灵敏度和总体准确度，以及（2）测量与ALT鉴定日期的一致性，对系统性能进行评价（与参比标准品相比）。测量：我们的一级创伤中心收治了199名创伤患者，初始损伤严重度评分（ISS）>= 16例患者在创伤后的前5天在重症监护室接受了ALI的评估。主要结果：该系统显示出87%的灵敏度（95%置信区间[CI] 82.3-91.7）和89%的特异性（95% CI 84.7-93.4）。它确定了ALI之前或在24小时内，在此期间，ALI被确定由两名审查员在87%cases.Conclusions：一个自动化的电子系统，屏幕插管[CI]创伤患者，不包括CHF患者，ALI的基础上CXR报告和ABGs的结果是足够准确的，以确定许多早期病例的ALI。
Objective: The authors designed an automated electronic system that incorporates data from multiple hospital information systems to screen for acute lung injury (ALI) in mechanically ventilated patients. The authors evaluated the accuracy of this system in diagnosing ALI in a cohort of patients with major trauma, but excluding patients with congestive heart failure (CHF).Design: Single-center validation study. Arterial blood gas (ABG) data and chest radiograph (CXR) reports for a cohort of intensive care unit (ICU) patients with major trauma but excluding patients with CHF were screened prospectively for ALI requiring intubation by an automated electronic system. The system was compared to a reference standard established through consensus of two blinded physician reviewers who independently screened the same population for ALI using all available ABG data and CXR images. The system's performance was evaluated (1) by measuring the sensitivity and overall accuracy, and (2) by measuring concordance with respect to the date of ALT identification (vs. reference standard).Measurements: One hundred ninety-nine trauma patients admitted to our level I trauma center with an initial injury severity score (ISS) >= 16 were evaluated for development of ALI in the first five days in m ICU after trauma.Main Results: The system demonstrated 87% sensitivity (95% confidence interval [CI] 82.3-91.7) and 89% specificity (95% CI 84.7-93.4). It identified ALI before or within the 24-hour period during which ALI was identified by the two reviewers in 87% of cases.Conclusions: An automated electronic system that screens intubated [CI] trauma patients, excluding patients with CHF, for ALI based on CXR reports and results of ABGs is sufficiently accurate to identify many early cases of ALI.