Document Detail

Performance of an automated electronic acute lung injury screening system in intensive care unit patients.
MedLine Citation:
PMID:  20959782     Owner:  NLM     Status:  In-Process    
OBJECTIVE: Lung protective ventilation reduces mortality in patients with acute lung injury, but underrecognition of acute lung injury has limited its use. We recently validated an automated electronic acute lung injury surveillance system in patients with major trauma in a single intensive care unit. In this study, we assessed the system's performance as a prospective acute lung injury screening tool in a diverse population of intensive care unit patients.
DESIGN: Patients were screened prospectively for acute lung injury over 21 wks by the automated system and by an experienced research coordinator who manually screened subjects for enrollment in Acute Respiratory Distress Syndrome Clinical Trials Network (ARDSNet) trials. Performance of the automated system was assessed by comparing its results with the manual screening process. Discordant results were adjudicated blindly by two physician reviewers. In addition, a sensitivity analysis using a range of assumptions was conducted to better estimate the system's performance.
SETTING: The Hospital of the University of Pennsylvania, an academic medical center and ARDSNet center (1994-2006).
PATIENTS: Intubated patients in medical and surgical intensive care units.
MEASUREMENTS AND MAIN RESULTS: Of 1270 patients screened, 84 were identified with acute lung injury (incidence of 6.6%). The automated screening system had a sensitivity of 97.6% (95% confidence interval, 96.8-98.4%) and a specificity of 97.6% (95% confidence interval, 96.8-98.4%). The manual screening algorithm had a sensitivity of 57.1% (95% confidence interval, 54.5-59.8%) and a specificity of 99.7% (95% confidence interval, 99.4-100%). Sensitivity analysis demonstrated a range for sensitivity of 75.0-97.6% of the automated system under varying assumptions. Under all assumptions, the automated system demonstrated higher sensitivity than and comparable specificity to the manual screening method.
CONCLUSIONS: An automated electronic system identified patients with acute lung injury with high sensitivity and specificity in diverse intensive care units of a large academic medical center. Further studies are needed to evaluate the effect of automated prompts that such a system can initiate on the use of lung protective ventilation in patients with acute lung injury.
Helen C Koenig; Barbara B Finkel; Satjeet S Khalsa; Paul N Lanken; Meeta Prasad; Richard Urbani; Barry D Fuchs
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-104     Citation Subset:  AIM; IM    
Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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MeSH Terms
Grant Support
Comment In:
Crit Care Med. 2011 Jan;39(1):209-10   [PMID:  21178542 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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