title: Clinician blood pressure documentation of stable intensive care patients: an intelligent archiving agent has a higher association with future hypotension.
abstract: OBJECTIVE
  To compare invasive blood pressure measurements recorded using an automated archiving method against clinician-documented values from the same invasive monitor and determine which method of recording blood pressure is more highly associated with the subsequent onset of hypotension.
  
  
  METHODS
  Retrospective comparative analysis.
  
  
  METHODS
  Intensive care patients in a university hospital.
  
  
  METHODS
  Mixed medical/surgical patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  Using intervals of hemodynamic stability from 2,320 patient records, we retrospectively compared paired sources of invasive blood pressure data: 1) measurements documented by the nursing staff and 2) measurements generated by an automated archiving method that intelligently excludes unreliable (e.g., noisy or excessively damped) blood pressure values. The primary outcome was the occurrence of subsequent "consensus" hypotension, i.e., hypotension documented jointly by the nursing staff and the automated archive. The automated method could be adjusted to alter its operating characteristics (sensitivity and specificity). At a matched level of specificity (96%), blood pressures from the automated archiving method were more sensitive (28%) for subsequent consensus hypotension vs. the nurse-documented values (21%). Likewise, at a matched level of sensitivity (21%), the values from the automated method were more specific (99%) vs. the nurse-documented values (96%). These significant findings (p < .001) were consistent in a set of sensitivity analyses that employed alternative criteria for patient selection and the clinical outcome definition.
  
  
  CONCLUSIONS
  During periods of hemodynamic stability in an intensive care unit patient population, clinician-documented blood pressure values were inferior to values from an intelligent automated archiving method as early indicators of hemodynamic instability. Human oversight may not be necessary for creating a valid archive of vital sign data within an electronic medical record. Furthermore, if clinicians do have a tendency to disregard early indications of instability, then an automated archive may be a preferable source of data for so-called early warning systems that identify patients at risk of decompensation.
authors.affiliation: Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA. chug@csail.mit.edu
authors.forename: Caleb W
authors.initials: CW
authors.lastname: Hug
authors.forename: Gari D
authors.initials: GD
authors.lastname: Clifford
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Reisner
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods*; D015924:Blood Pressure Monitors; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004282:Documentation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D007022:Hypotension / Q000517:prevention & control*; D007362:Intensive Care Units; D008297:Male; D016347:Medical Records Systems, Computerized; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010817:Physician-Patient Relations; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity