Decision support for the triage of lung transplant recipients on the basis of home-monitoring spirometry and symptom reporting.
Purpose The objective of this study was to develop and evaluate a computerized rule-based decision support algorithm for nursing triage of potential acute bronchopulmonary events in lung transplant recipients on the basis of home monitoring of spirometry and symptoms. Methods The algorithm automatically separates recipients into 2 groups: those who are stable or improving and those who should be "watched" further because of their potential for developing bronchopulmonary events according to their weekly home-monitoring measurements. A total of 155 recipients (82 females and 73 males) contributed 1944 weekly records for the training (420), testing (786), and prospective evaluation (738) data sets. Weekly records contained daily values of forced expiratory volume at 1 second and respiratory symptoms, which were the inputs for the triage rules. Results Sensitivity and specificity were greater than 90% for the prospective evaluation comparing the computer decision support system with the manual nurse review of the same home-monitoring reports. Conclusions Algorithm performance in identifying lung recipients who should be placed on a "watch" list for the potential to develop acute bronchopulmonary events is comparable to the standard human clinical review of the same weekly home-monitoring data.
Finkelstein
Stanley M
SM
Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Scudiero
Anthony
A
Lindgren
Bruce
B
Snyder
Mariah
M
Hertz
Marshall I
MI
D000465:Algorithms; D003201:Computers; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000503:physiopathology; D016040:Lung Transplantation; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D024802:Nurse's Role; D011183:Postoperative Complications / Q000175:diagnosis; D013147:Spirometry; D014218:Triage