title: Predictive monitoring for early detection of subacute potentially catastrophic illnesses in critical care.
abstract: We wish to save lives of patients admitted to ICUs. Their mortality is high enough based simply on the severity of the original injury or illness, but is further raised by events during their stay. We target those events that are subacute but potentially catastrophic, such as infection. Sepsis, for example, is a bacterial infection of the bloodstream, that is common in ICU patients and has a >25% risk of death. Logically, early detection and treatment with antibiotics should improve outcomes. Our fundamental precepts are (1) some potentially catastrophic medical and surgical illnesses have subclinical phases during which early diagnosis and treatment might have life-saving effects, (2) these phases are characterized by changes in the normal highly complex but highly adaptive regulation and interaction of the nervous system and other organs such as the heart and lungs, (3) teams of clinicians and quantitative scientists can work together to identify clinically important abnormalities of monitoring data, to develop algorithms that match the clinicians' eye in detecting abnormalities, and to undertake the clinical trials to test their impact on outcomes.
authors.affiliation: Department of Internal Medicine, University of Virginia, Box 800158, Charlottesville, VA 22908, USA. rmoorman@virginia.edu
authors.forename: J Randall
authors.initials: JR
authors.lastname: Moorman
authors.forename: Craig E
authors.initials: CE
authors.lastname: Rusin
authors.forename: Hoshik
authors.initials: H
authors.lastname: Lee
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Guin
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Clark
authors.forename: John B
authors.initials: JB
authors.lastname: Delos
authors.forename: John
authors.initials: J
authors.lastname: Kattwinkel
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Lake
mesh_terms: D002388:Catastrophic Illness / Q000401:mortality*; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008991:Monitoring, Physiologic / Q000401:mortality*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014768:Virginia / Q000453:epidemiology