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Evaluation of standard versus nonstandard vital signs monitors in the prehospital and emergency departments: Results and lessons learned from a trauma patient care protocol

Liu, Nehemiah T. MS; Holcomb, John B. MD; Wade, Charles E. PhD; Darrah, Mark I. PhD; Salinas, José PhD

Journal of Trauma and Acute Care Surgery: September 2014 - Volume 77 - Issue 3 - p S121–S126
doi: 10.1097/TA.0000000000000192
Clinical Science: Prehospital Care

BACKGROUND: This study aimed to determine the effectiveness of using a wireless, portable vital signs monitor (WVSM) for predicting the need for lifesaving interventions (LSIs) in the emergency department (ED) and use a multivariate logistic regression model to determine whether the WVSM was an improved predictor of LSIs in the ED over the standard of care monitor currently being used.

METHODS: This study analyzed 305 consecutive patients transported from the scene via helicopter to a Level I trauma center. For 104 patients in the study, a WVSM was also attached to the patient’s arm and used to record and display prehospital and hospital physiologic data in real time on a handheld computer and in the trauma bay. Multivariate logistic regression analyses were performed for accuracy in predicting needs for LSIs in control and WVSM subjects. In addition, receiver operating characteristic curves were obtained to examine the discriminating power of the models for the outcome of one or more LSIs in the ED.

RESULTS: Of the 305 patients, 73 underwent 109 LSIs in the ED. Of these, 21 patients wore the WVSM during transport in addition to the standard monitor. Logistic regression analysis revealed that heart rate, respiratory rate, and systolic blood pressure were significantly associated with an increased risk for LSIs in the ED (p < 0.05). Receiver operating characteristic curve analysis also demonstrated better prediction for LSIs performed in the ED in WVSM subjects than in control subjects (area under the curve, 0.86 vs. 0.81, respectively).

CONCLUSION: The WVSM system leads to improved LSI accuracy in the ED. In addition, many important lessons have been learned in preparation for this study. Adoption of nonstandard vital signs monitors into critical care/trauma medicine may require a new paradigm of personnel education, training, and practice.

LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

From the US Army Institute of Surgical Research (N.T.L., J.S.), Fort Sam Houston, San Antonio; and Center for Translational Injury Research (J.B.H., C.E.W.), Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas; Athena GTX, Inc. (M.I.D.), Des Moines, Iowa.

Submitted: November 26, 2013, Revised: December 12, 2013, Accepted: December 26, 2014, Published online: April 24, 2014.

This study was conducted under a protocol reviewed and approved by the University of Texas Health Science Center at Houston and in accordance with the approved protocol.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Address for reprints: Nehemiah T. Liu, MS, US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234-6315; email: nehemiah.liu@us.army.mil.

© 2014 Lippincott Williams & Wilkins, Inc.