Document Detail


Clinician blood pressure documentation of stable intensive care patients: an intelligent archiving agent has a higher association with future hypotension.
MedLine Citation:
PMID:  21336136     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare invasive blood pressure measurements recorded using an automated archiving method against clinician-documented values from the same invasive monitor and determine which method of recording blood pressure is more highly associated with the subsequent onset of hypotension.
DESIGN: Retrospective comparative analysis.
SETTING: Intensive care patients in a university hospital.
PATIENTS: Mixed medical/surgical patients.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Using intervals of hemodynamic stability from 2,320 patient records, we retrospectively compared paired sources of invasive blood pressure data: 1) measurements documented by the nursing staff and 2) measurements generated by an automated archiving method that intelligently excludes unreliable (e.g., noisy or excessively damped) blood pressure values. The primary outcome was the occurrence of subsequent "consensus" hypotension, i.e., hypotension documented jointly by the nursing staff and the automated archive. The automated method could be adjusted to alter its operating characteristics (sensitivity and specificity). At a matched level of specificity (96%), blood pressures from the automated archiving method were more sensitive (28%) for subsequent consensus hypotension vs. the nurse-documented values (21%). Likewise, at a matched level of sensitivity (21%), the values from the automated method were more specific (99%) vs. the nurse-documented values (96%). These significant findings (p < .001) were consistent in a set of sensitivity analyses that employed alternative criteria for patient selection and the clinical outcome definition.
CONCLUSIONS: During periods of hemodynamic stability in an intensive care unit patient population, clinician-documented blood pressure values were inferior to values from an intelligent automated archiving method as early indicators of hemodynamic instability. Human oversight may not be necessary for creating a valid archive of vital sign data within an electronic medical record. Furthermore, if clinicians do have a tendency to disregard early indications of instability, then an automated archive may be a preferable source of data for so-called early warning systems that identify patients at risk of decompensation.
Authors:
Caleb W Hug; Gari D Clifford; Andrew T Reisner
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-08-18     Revised Date:  2014-09-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1006-14     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure Determination / methods*
Blood Pressure Monitors
Cohort Studies
Critical Illness
Documentation
Female
Humans
Hypertension / diagnosis
Hypotension / prevention & control*
Intensive Care / methods*
Intensive Care Units*
Male
Medical Records Systems, Computerized*
Monitoring, Physiologic / instrumentation,  methods*
Physician-Patient Relations
Point-of-Care Systems
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Grant Support
ID/Acronym/Agency:
LM 07092/LM/NLM NIH HHS; R01 EB001659/EB/NIBIB NIH HHS; R01 EB001659/EB/NIBIB NIH HHS; R01 EB001659-09/EB/NIBIB NIH HHS; T15 LM007092/LM/NLM NIH HHS
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