Evaluation of standard versus nonstandard vital signs monitors in the prehospital and emergency departments: results and lessons learned from a trauma patient care protocol.
BACKGROUND
This study aimed to determine the effectiveness of using a wireless, portable vital signs monitor (WVSM) for predicting the need for lifesaving interventions (LSIs) in the emergency department (ED) and use a multivariate logistic regression model to determine whether the WVSM was an improved predictor of LSIs in the ED over the standard of care monitor currently being used.


METHODS
This study analyzed 305 consecutive patients transported from the scene via helicopter to a Level I trauma center. For 104 patients in the study, a WVSM was also attached to the patient's arm and used to record and display prehospital and hospital physiologic data in real time on a handheld computer and in the trauma bay. Multivariate logistic regression analyses were performed for accuracy in predicting needs for LSIs in control and WVSM subjects. In addition, receiver operating characteristic curves were obtained to examine the discriminating power of the models for the outcome of one or more LSIs in the ED.


RESULTS
Of the 305 patients, 73 underwent 109 LSIs in the ED. Of these, 21 patients wore the WVSM during transport in addition to the standard monitor. Logistic regression analysis revealed that heart rate, respiratory rate, and systolic blood pressure were significantly associated with an increased risk for LSIs in the ED (p < 0.05). Receiver operating characteristic curve analysis also demonstrated better prediction for LSIs performed in the ED in WVSM subjects than in control subjects (area under the curve, 0.86 vs. 0.81, respectively).


CONCLUSIONS
The WVSM system leads to improved LSI accuracy in the ED. In addition, many important lessons have been learned in preparation for this study. Adoption of nonstandard vital signs monitors into critical care/trauma medicine may require a new paradigm of personnel education, training, and practice.


METHODS
Therapeutic/care management, level IV.
From the US Army Institute of Surgical Research (N.T.L., J.S.), Fort Sam Houston, San Antonio; and Center for Translational Injury Research (J.B.H., C.E.W.), Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas; Athena GTX, Inc. (M.I.D.), Des Moines, Iowa.
Nehemiah T
NT
Liu
John B
JB
Holcomb
Charles E
CE
Wade
Mark I
MI
Darrah
José
J
Salinas
D000293:Adolescent; D000328:Adult; D061906:Advanced Trauma Life Support Care / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002985:Clinical Protocols / Q000592:standards; D034201:Computers, Handheld; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D012372:ROC Curve; D056152:Respiratory Rate / Q000502:physiology; D055986:Vital Signs / Q000502:physiology*; D059015:Wireless Technology / Q000295:instrumentation; D014947:Wounds and Injuries / Q000503:physiopathology* / Q000628:therapy; D055815:Young Adult