大规模输血协议在现代电子医疗记录中的预测建模
William Shihao Lao1, Jessica L Poisson2, Cory J Vatsaas1
1From the Department of Surgery, Duke University Medical Center, Durham, NC.
概括
大规模输血协议 (MTP) 激活的预测模型被整合到电子病历 (EMR) 中. 这个模型准确地预测了MTP的激活和交付,性能随着时间的推移而得到改善.
科学领域:
- 医疗信息学 医疗信息学
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
背景情况:
- 埃莫里模型被选中用于整合到医院的EMR中,作为预测大规模输血协议 (MTP) 激活的实时临床决策支持工具.
- 该模型的连续可变输出方便定期重新校准以优化灵敏度和特异性.
研究的目的:
- 将MTP激活和传递的预测模型集成到电子病历 (EMR) 中.
- 用前性收集的数据对模型进行外部验证,并评估其随时间推移的准确性和精度.
主要方法:
- 使用从创伤激活中前性收集的数据,输入心率,缩血压,基础过量 (BE) 和损伤机制到EMR集成模型中.
- 提供MTP被定义为6个单位的包装红细胞/6小时 (MTP1) 或24小时内10个单位 (MTP2).
- 接收器操作特征 (ROC) 和精度召回 (PR) 曲线在6,12和20个月时构建,以评估模型性能.
主要成果:
- 分析了1162名患者的数据.
- 20个月后MTP激活,MTP1和MTP2交付的ROC曲线下的面积分别为0.831,0.879和0.905 (所有P<0.001).
- 在20个月的PR曲线下的面积达到MTP激活的0.371,MTP1的0.339,MTP2交付的0.355.
结论:
- 一个MTP激活和交付的预测模型成功地集成到EMR中并得到外部验证.
- 该模型随着时间的推移表现出更好的性能,连续概率输出允许优化灵敏度和特异性.
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