title: A comparison of alerting strategies for hemorrhage identification during prehospital emergency transport.
abstract: Early and accurate identification of physiological abnormalities is one feature of intelligent decision support. The ideal analytic strategy for identifying pathological states would be highly sensitive and highly specific, with minimal latency. In the field of manufacturing, there are well-established analytic strategies for statistical process control, whereby aberrancies in a manufacturing process are detected by monitoring and analyzing the process output. These include simple thresholding, the sequential probability ratio test (SPRT), risk-adjusted SPRT, and the cumulative sum method. In this report, we applied these strategies to continuously monitored prehospital vital-sign data from trauma patients during their helicopter transport to level I trauma centers, seeking to determine whether one strategy would be superior. We found that different configurations of each alerting strategy yielded widely different performances in terms of sensitivity, specificity, and average time to alert. Yet, comparing the different investigational analytic strategies, we observed substantial overlap among their different configurations, without any one analytic strategy yielding distinctly superior performance. In conclusion, performance did not depend as much on the specific analytic strategy as much as the configuration of each strategy. This implies that any analytic strategy must be carefully configured to yield the optimal performance (i.e., the optimal balance between sensitivity, specificity, and latency) for a specific use case. Conversely, this also implies that an alerting strategy optimized for one use case (e.g., long prehospital transport times) may not necessarily yield performance data that are optimized for another clinical application (e.g., short prehospital transport times, intensive care units, etc.).
authors.forename: Jianbo
authors.initials: J
authors.lastname: Liu
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Reisner
authors.forename: Shwetha
authors.initials: S
authors.lastname: Edla
authors.forename: Jaques
authors.initials: J
authors.lastname: Reifman
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014187:Transportation of Patients