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Validation of an electronic surveillance system for acute lung injury

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Abstract

Objective

Early detection of acute lung injury (ALI) is essential for timely implementation of evidence-based therapies and enrollment into clinical trials. We aimed to determine the accuracy of computerized syndrome surveillance for detection of ALI in hospitalized patients and compare it with routine clinical assessment.

Design

Using a near-real time copy of the electronic medical records, we developed and validated a custom ALI electronic alert (ALI “sniffer”) based on the European-American Consensus Conference Definition and compared its performance against provider-derived documentation.

Patients and setting

A total of 3,795 consecutive critically ill patients admitted to nine multidisciplinary intensive care units (ICUs) of a tertiary care teaching institution were included.

Measurements and main results

ALI developed in 325 patients and was recognized by bedside clinicians in only 86 (26.5%). Under-recognition of ALI was associated with not implementing protective mechanical ventilation (median tidal volumes of 9.2 vs. 8.0 ml/kg predicted body weight, P < 0.001). ALI “sniffer” demonstrated excellent sensitivity of 96% (95% CI 94–98) and moderate specificity of 89% (95% CI 88–90) with a positive predictive value ranging from 24% (95% CI 13–40) in the heart–lung transplant ICU to 64% (95% CI 55–71) in the medical ICU.

Conclusions

The computerized surveillance system accurately identifies critically ill patients who develop ALI syndrome. Since the lack of ALI recognition is a barrier to the timely implementation of best practices and enrollment into research studies, computerized syndrome surveillance could be a useful tool to enhance patient safety and clinical research.

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Acknowledgments

This publication was made possible by grant no. 1 KL2 RR024151 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), the NIH Roadmap for Medical Research and the Mayo Foundation. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Reengineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overviewtranslational.asp. This study was supported in part by NHLBI K23 HL78743-01A1 and NIH KL2 RR024151.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Vitaly Herasevich, Murat Yilmaz, Hasrat Khan, Rolf D. Hubmayr & Ognjen Gajic

  2. Department of Critical Care Services, MeritCare Medical Center, 801 Broadway N, Fargo, ND, 58122, USA

    Hasrat Khan

  3. Department of Anesthesiology and Intensive Care, Medical Faculty, Akdeniz University (MY), Antalya, Turkey

    Murat Yilmaz

Authors
  1. Vitaly Herasevich
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  2. Murat Yilmaz
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  3. Hasrat Khan
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  4. Rolf D. Hubmayr
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  5. Ognjen Gajic
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Corresponding author

Correspondence to Ognjen Gajic.

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Herasevich, V., Yilmaz, M., Khan, H. et al. Validation of an electronic surveillance system for acute lung injury. Intensive Care Med 35, 1018–1023 (2009). https://doi.org/10.1007/s00134-009-1460-1

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  • DOI: https://doi.org/10.1007/s00134-009-1460-1

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