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Review and performance evaluation of aggregate weighted 'track and trigger' systems
Gary B Smith1, David R Prytherch, Paul E Schmidt
1Portsmouth Hospitals NHS Trust and University of Bournemouth, UK. gary.smith@porthosp.nhs.uk
Resuscitation
|February 6, 2008
Summary
Aggregate weighted
Area of Science:
- Critical Care Medicine
- Clinical Monitoring
- Health Informatics
Background:
- Physiologically based, aggregate weighted 'track and trigger' systems (AWTTS) are widely used but lack updated literature reviews.
- Existing data on the predictive ability of AWTTS for serious adverse outcomes are limited.
Purpose of the Study:
- To systematically review and describe AWTTS currently in clinical use.
- To evaluate the ability of AWTTS to discriminate between hospital survivors and non-survivors using vital signs data.
Main Methods:
- A systematic literature review identified 33 unique AWTTS.
- The discriminatory performance of AWTTS was assessed using the area under the receiver-operating characteristics (AUROC) curve.
- Analysis included a database of 9987 vital signs datasets.
Main Results:
- AUROC values for AWTTS ranged from 0.657 to 0.782.
- Twelve AWTTS (36%) demonstrated reasonable discrimination between survivors and non-survivors.
- Top-performing AWTTS incorporated age (AUROCs 0.722-0.782) and temperature.
Conclusions:
- A diverse range of similar AWTTS are in clinical use with inconsistencies in physiological components.
- Most AWTTS showed poor performance in discriminating outcomes, though 36% performed reasonably well.
- Physiological data can predict outcomes, but AWTTS models require further refinement.
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