Use of a continuous single lead electrocardiogram analytic to predict patient deterioration requiring rapid response team activation

Abstract

Identifying the onset of patient deterioration is challenging despite the potential to respond to patients earlier with better vital sign monitoring and rapid response team (RRT) activation. In this study an ECG based software as a medical device, the Analytic for Hemodynamic Instability Predictive Index (AHI-PI), was compared to the vital signs of heart rate, blood pressure, and respiratory rate, evaluating how early it indicated risk before an RRT activation. A higher proportion of the events had risk indication by AHI-PI (92.71%) than by vital signs (41.67%). AHI-PI indicated risk early, with an average of over a day before RRT events. In events whose risks were indicated by both AHI-PI and vital signs, AHI-PI demonstrated earlier recognition of deterioration compared to vital signs. A case-control study showed that situations requiring RRTs were more likely to have AHI-PI risk indication than those that did not. The study derived several insights in support of AHI-PI's efficacy as a clinical decision support system. The findings demonstrated AHI-PI's potential to serve as a reliable predictor of future RRT events. It could potentially help clinicians recognize early clinical deterioration and respond to those unnoticed by vital signs, thereby helping clinicians improve clinical outcomes.

Fig 1. Identifying the study cohort and dataset.

Fig 2. AHI-PI and vital signs initial risk indication time.

This example shows hypotension and tachycardia having occurred prior to RRT activation. Icons courtesy of Fifth Eye, used under a CC-BY license.

Fig 3. Table and flowchart summarizing presence (Y) / absence (N) of risk indication.

Fig 4. Distributions of AHI-PI initial risk indication times for the three subgroups.

Fig 5. Distributions of AHI-PI initial risk indication times for the three subgroups by unit type.

Fig 6

Boxplots showing the distribution of vital signs initial risk indication times (top) as well as the distribution of AHI-PI initial risk indication times (bottom) for subgroup 1A.

Fig 7

Distributions of EHR-recorded SBP, MAP, respiratory rate, and pulse values between the vital signs initial risk indication time and event time and of percentages of AHI-PI risk indications between AHI-PI initial risk indication time and event time (subgroup 1A). Y-axis label ‘bpm*’ is either beats per minute (heart rate) or breaths per minute (respiratory rate) depending on the context.

Fig 8

Distributions of initial risk indication times for vital signs and AHI-PI by unit type (subgroup 1A).