用机器学习从噪声中识别导管使用信号,实现自动记录。
Needles in Needle Stacks: Meaningful Clinical Information Buried in Noisy Waveform Data
- 通过分析波形数据中的特定伪影,识别导管使用事件。
- 在儿童医院实测中实现近实时检测,准确率高。
- 适合临床监控系统开发与患者安全研究者参考。
中心静脉导管(C-Lines)和动脉导管(A-Lines)在重症监护室(CCU)常用于采血、给药及高频血压监测。合理使用这些导管至关重要,过度使用与住院期间显著的发病率和死亡率相关。记录导管使用频率是降低不良后果的重要步骤。然而,当前标准记录方式依赖人工,易出错、遗漏或存在偏差。来自这些导管传感器的高频血压波形数据通常噪声大、含大量伪影。传统信号处理方法会在分析前去除噪声伪影。但根据床旁观察,我们发现每次导管使用都会产生一种独特的伪影,该伪影深埋于生理波形和额外噪声之中。本文聚焦于可从波形数据中实时检测此类伪影的机器学习(ML)模型——即在“针堆中找针”,以实现导管使用自动记录。我们在一家大型儿童医院构建并评估了实时运行的ML分类器,验证了其在减轻文档负担、提升床边医生可用信息量以及支持科室级患者安全改进举措方面的有效性。
原文摘要 · Abstract (English)
Central Venous Lines (C-Lines) and Arterial Lines (A-Lines) are routinely used in the Critical Care Unit (CCU) for blood sampling, medication administration, and high-frequency blood pressure measurement. Judiciously accessing these lines is important, as over-utilization is associated with significant in-hospital morbidity and mortality. Documenting the frequency of line-access is an important step in reducing these adverse outcomes. Unfortunately, the current gold-standard for documentation is manual and subject to error, omission, and bias. The high-frequency blood pressure waveform data from sensors in these lines are often noisy and full of artifacts. Standard approaches in signal processing remove noise artifacts before meaningful analysis. However, from bedside observations, we characterized a distinct artifact that occurs during each instance of C-Line or A-Line use. These artifacts are buried amongst physiological waveform and extraneous noise. We focus on Machine Learning (ML) models that can detect these artifacts from waveform data in real-time - finding needles in needle stacks, in order to automate the documentation of line-access. We built and evaluated ML classifiers running in real-time at a major children's hospital to achieve this goal. We demonstrate the utility of these tools for reducing documentation burden, increasing available information for bedside clinicians, and informing unit-level initiatives to improve patient safety.
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