Deployment and Assessment of an Automated Trauma Care Decision Support System
Abstract
It has been estimated that 24% of U.S. battlefield deaths died despite potentially survivable injuries. This has led the U.S. Army to make the development of technology for automated decision support a leading priority. In its 2015 Capability Cap Closure Analysis, the U.S. DoD identified a leading military health capability gap was the “[l]ack [of] a decision support mechanism that enables timely, accurate decisions and diagnosis at all levels of care.” Such clinical decision support (CDS) capabilities will also be directly applicable to multi-domain operations including operations in dense urban environments. Despite academic and industry effort to develop clinical decision-support systems (CDSS) capabilities for trauma patient care, the technology has not matured enough to be accepted by clinicians, because either the novel technology does not perform well enough, or does not integrate into existing care systems/workflows. Relevance to Topic Area(s): This proposed research project addresses the following FY20 PRMRP Hemorrhage Control Area of Encouragement: “Research on strategies for … treatment for hemorrhage, coagulopathy of trauma, and hemodynamic decompensation/ hypovolemic shock.” The technology will also be applicable to “[d]evelopment of innovative damage control resuscitation and damage control surgical and nonsurgical capabilities, especially interventions to be used in an austere environment by non-physician providers” and “[r]esearch to evaluate the effects of current combat blood product transfusion guidelines on immunological status and clinical outcomes.” The proposed research project also addresses the following FY20 Respiratory Health Care of Encouragement: “Research on the etiology and prevention of acute respiratory distress syndrome (ARDS) caused by host responses to trauma, transfusion, mechanical ventilation, burns, infection, hemorrhagic shock, inhalation, and/or oxygen exposure.” This project will involve live testing of a hemorrhage management and respiratory health CDSS engineered for accuracy, validity, and user needs. By studying both technical characteristics and user perceptions of the investigational system, the trial results will help define essential requirements for a new generation of impactful hemorrhage CDSS. After receiving the appropriate regulatory clearance, we will use the CDSS for actual trauma patient care, under careful observation to ensure it is safe and effective. We will study the performance of the system, and the aspects that clinicians (doctors and nurses and physician assistants) like and dislike, and ultimately determine what functional requirements are necessary for clinicians to feel that the system is appropriate for routine use during trauma patient care. Since hemorrhage is the single leading cause of preventable death on the battlefield, this CDSS will help the military. Yet hemorrhage is also the leading cause of preventable death after injury in civilian populations, and injury is a leading cause of death for young and middle aged civilian adults. Advancing the field of automated CDSS during the management of unstable trauma patients will be particularly impactful when caregivers are novice, distracted, or fatigued. What we learn in this project about user needs for trauma CDSS, as well as the actual software itself, will be applicable to military hospitals and could also be adapted for field use, including during prolonged durations before evacuation can be accomplished.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110781
Entities
People
- Andrew Reisner
Organizations
- Massachusetts General Hospital
- United States Army