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      Automated Analysis and Annotation of Datasets from Patients with Severe Traumatic Brain Injury: an Initial Case Study

      , ,

      BCS Health Informatics Scotland (HIS)

      Health Informatics Scotland

      11 & 12 October 2016

      Traumatic Brain Injury, ICU, patient monitoring, Hypoxia, correlation, workbench, data analysis

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          Treatment protocols for patients who have suffered traumatic brain injury (TBI) specify that hypoxia should be avoided and specifically that brain oxygen tension (PbtO2) should be maintained above a particular level (20mmHg). Results from several specialized Neuro ICUs world-wide suggest that such guidelines are not achieved in at least 24% of patients (Shafi et al. 2014). Many physiological and therapeutic factors can influence PbtO2. Furthermore, clinical staff in ICUs have many calls on their time and may not be able to direct sufficient attention to the management of a single parameter in one of several patients. We believe that automated analysis of complex data sets could be a useful step to developing software capable of assisting in the better maintenance of PbtO2 in these complex patients.

          A “manual” analysis of 5 patients’ complete temporal records showed that certain distinct rules including a number of important descriptors (CPP, PbtO2, PaO2 & the correlation coefficient between CPP and PbtO2) with their values segmented into discrete ranges, cover 98.2% (SD 1.6) of the available dataset once the rules have been “fine-tuned”. This study was then validated in a second set of five patients, in which 92.5% (SD 12.5) of the data set was covered without additional “tuning” of the rules. Moreover, it was noted that these patterns, once some account was taken of noise, occur in “blocks”. As a result of these observations we developed a correlation module for the existing Temporal Discovery workbench to replicate the “manual” analysis. Using the dataset for the 10 patients, we have now obtained effectively perfect agreement between the manual analysis and that produced by the workbench. Subsequently, the expert provided clinical actions which correspond to each of the (48) patterns potentially created in this study, and so the correlation module is now able to produce for each time-point (and each time “block”) a pattern, and the correct clinical action.

          Further work includes enhancing how the correlation module deals with noise, evaluating the approach across a much larger dataset, and evaluating the effectiveness of the module’s recommendations in clinical settings.

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          Most cited references 4

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          Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring.

          An intracranial pressure (ICP) monitor, from which cerebral perfusion pressure (CPP) is estimated, is recommended in the care of severe traumatic brain injury (TBI). Nevertheless, optimal ICP and CPP management may not always prevent cerebral ischemia, which adversely influences patient outcome. The authors therefore determined whether the addition of a brain tissue oxygen tension (PO2) monitor in the treatment of TBI was associated with an improved patient outcome. Patients with severe TBI (Glasgow Coma Scale [GCS] score < 8) who had been admitted to a Level I trauma center were evaluated as part of a prospective observational database. Patients treated with ICP and brain tissue PO2 monitoring were compared with historical controls matched for age, pathological features, admission GCS score, and Injury Severity Score who had undergone ICP monitoring alone. Therapy in both patient groups was aimed at maintaining an ICP less than 20 mm Hg and a CPP greater than 60 mm Hg. Among patients whose brain tissue PO2 was monitored, oxygenation was maintained at levels greater than 25 mm Hg. Twenty-five patients with a mean age of 44 +/- 14 years were treated using an ICP monitor alone. Twenty-eight patients with a mean age of 38 +/- 18 years underwent brain tissue PO2-directed care. The mean daily ICP and CPP levels were similar in each group. The mortality rate in patients treated using conventional ICP and CPP management was 44%. Patients who also underwent brain tissue PO2 monitoring had a significantly reduced mortality rate of 25% (p < 0.05). The use of both ICP and brain tissue PO2 monitors and therapy directed at brain tissue PO2 is associated with reduced patient death following severe TBI.
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            Brain multimodality monitoring: an update.

            An important goal of neurocritical care is the management of secondary brain injury (SBI), that is pathological events occurring after primary insult that add further burden to outcome. Brain oedema, cerebral ischemia, energy dysfunction, seizures and systemic insults are the main components of SBI. We here review recent data showing the clinical utility of brain multimodality monitoring (BMM) for the management of SBI. Despite being recommended by international guidelines, standard intracranial pressure (ICP) monitoring may be insufficient to detect all episodes of SBI. ICP monitoring, combined with brain oxygen (PbtO(2)), cerebral microdialysis and regional cerebral blood flow, might help to target therapy (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Physiological parameters derived from BMM, including PbtO(2) and microdialysis lactate/pyruvate ratio, correlate with outcome and have recently been incorporated into neurocritical care guidelines. Advanced intracranial devices can be complemented by quantitative electroencephalography to monitor changes of brain function and nonconvulsive seizures. BMM offers an on-line comprehensive scrutiny of the injured brain and is increasingly used for the management of SBI. Integration of monitored data using new informatics tools may help optimize therapy of brain-injured patients and quality of care.
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              Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries.

              Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome.

                Author and article information

                October 2016
                October 2016
                : 1-7
                Department of Computing Science University of Aberdeen
                Intensive Care Unit Western General Hospital Edinburgh EH4 2XU
                © The Authors. Published by BCSProceedings of BCS Health Informatics Scotland 2016 Conference.

                This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit

                BCS Health Informatics Scotland
                Glasgow, UK
                11 & 12 October 2016
                Electronic Workshops in Computing (eWiC)
                Health Informatics Scotland
                Product Information: 1477-9358BCS Learning & Development
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                Electronic Workshops in Computing


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