Outcome prediction in chest injury by a mathematical search and display program.
OBJECTIVE
This study applies a stochastic or probability search and display model to prospectively predict outcome and to evaluate therapeutic effects in a consecutively monitored series of 396 patients with severe thoracic and thoracoabdominal injuries.


METHODS
Prospective observational study of outcome prediction using noninvasive hemodynamic monitoring by previously designed protocols and tested against actual outcome at hospital discharge in a level 1 trauma service of a university-run, inner-city public hospital.


METHODS
Cardiac index (CI), heart rate (HR), mean arterial pressure (MAP), arterial oxygen saturation measured by pulse oximetry (Sp(O2)), transcutaneous oxygen tension (PtC(O2)), and transcutaneous carbon dioxide tension (Ptc(CO2)) were monitored beginning shortly after admission to the emergency department. The stochastic search and display model with a decision support program based on noninvasive hemodynamic monitoring was applied to 396 severely ill patients with major thoracic and thoracoabdominal trauma. The survival probability (SP) was calculated during initial resuscitation continuously until patients were stabilized, and compared with the actual outcome when the patient was discharged from the hospital usually a week or more later.


RESULTS
The CI, Sp(O2), Ptc(O2), and MAP were appreciably higher in survivors than in nonsurvivors. HR and Ptc(CO2) were higher in the nonsurvivors. The calculated SP in the first 24-h observation period of survivors of chest wounds averaged 83 +/- 18% (+/- SD) and 62 +/- 19% for nonsurvivors. Misclassifications were 9.6%. The relative effects of alternative therapies were evaluated before and after therapy, using hemodynamic monitoring and SP as criteria.


CONCLUSIONS
Noninvasive hemodynamic monitoring with an information system provided a feasible approach to early outcome predictions and therapeutic decision support.
Shoemaker
William C
WC
Department of Surgery, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Room 9900, 1200 North State St, Los Angeles, CA 90033, USA. wcshoemaker00@hotmail.com
Bayard
David S
DS
Wo
Charles C J
CC
Chan
Linda S
LS
Chien
Li-Chien
LC
Lu
Kevin
K
Jelliffe
Roger W
RW
D000328:Adult; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D002302:Cardiac Output; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D013269:Stochastic Processes; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
D002245:Carbon Dioxide