A Multiplex Precision Medicine System for Early Warning of Progression Toward Shock After Trauma
Abstract
In an e-mail from Baghdad dated June 20, 2007, military physicians stated “there are three groups of casualties: (1) the ones who are really sick and (almost) everyone knows it; (2) the ones who have minimal injuries and will live almost regardless of what we do; (3) those who look like they aren't too bad but then deteriorate. (We are) most interested in identifying Group 3.” (Convertino) After traumatic injury, the existing methods of monitoring patients who appear to be stable are not good at predicting which patients will remain stable and which will go into shock. Our objective is to develop an inexpensive non-invasive system that gives healthcare providers an accurate and early notification that a patient, who initially appeared stable after an injury, has begun to deteriorate. Previous devices for this purpose have performed poorly. We believe that was because they used a single sensor to gather conventional information at a single point in time. Our system will gather signals continuously from multiple sites on the patient using state-of-the-art sensors and computational technologies. Our alignment with the second and third goals of Focus Area 4 is essentially perfect. Our research is aimed at helping patients who have suffered traumatic injury, appear to be stable, but are actually deteriorating due to problems such as ongoing bleeding. Before shock sets in, the system provides an early alert of an unexpected change in a patient’s condition, prompting medical providers to undertake tests seeking a diagnosis, treatment such as surgery, and/or stabilization prior to evacuation. Our device can be used in forward deployed field hospitals, transport vehicles, aircraft, Emergency Departments, and in-patient hospital wards. The system will be non-invasive in that the only physical contact with the patient will be stickers on the skin providing information either wirelessly or through wires like those used to record an electrocardiogram (EKG). Successful development of our system will benefit patients directly in that they will be monitored continuously for early signs of deterioration. Medical teams will benefit in that they will be free to focus their attention and resources on patients who have been correctly identified as needing immediate care while our system continuously monitors their other patients. Accurate and timely patient care allows for efficient use of medical resources on many levels. Its principal risks are limited to the computer program reaching incorrect conclusions after collecting data from the patient. If the system does not detect that a patient is unexpectedly getting sicker, then the patient will not get the help they need as early as possible. If the system incorrectly identifies a stable patient as not stable, then medical personnel spend time, effort, and resources determining that the patient is indeed stable. That stable patient might undergo unnecessary tests, delays in transport, or delays receiving appropriate treatment. We expect to complete our project in three phases over 3 years. In the first year, we will develop a prototype system and the computer programming in an animal model. In the second year, we will develop the system further and refine the computer programming in human models of ongoing hemorrhage. In the third year, we will undertake final development of the clinical system and its diagnostic algorithms, and test the system in Emergency Department trauma patients. Our device could be used for victims of trauma at all levels of medical care in military as well as civilian spheres thus benefiting Service members, Veterans, and their families.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jul 03, 2019
- Source ID
- W81XWH1820076
Entities
People
- Norman Paradis
Organizations
- Dartmouth–Hitchcock Medical Center
- United States Army