SC2i firmly believes a single enhanced decision has the potential to not only improve clinical outcomes for critically ill patients but also reduce costs, across the continuum of care.
The tools listed below, current and planned, are designed to enable such enhanced decisions:
IFI Tool
Status-Live
Protocol-Invasive Fungal Infections (IFI)
Description-Invasive fungal infections (IFI) are devastating and threaten both life and limb. Typically rare in immunocompetent individuals, IFI have developed with remarkable frequency in severely combat-injured patients, particularly those sustaining multi-system blast trauma with associated abdomino-pelvic injuries, multiple amputations, and/or requiring massive early lifesaving transfusions. Despite the high survival rate of our wounded warriors from the current conflicts, some such patients have succumbed to these aggressive infections after reaching military medical centers. Surviving patients have complex, morbid clinical courses frequently requiring multiple additional procedures and proximal migration of amputations, with high associated complication rates. Using a large database of combat-injured personnel, we have developed Clinical Decision Support Tools to allow early IFI risk stratification at either the in-theater or medical center echelons of care; these tools were subsequently externally validated utilizing a separate, similar database. These tools can facilitate the early diagnosis and aggressive prophylactic local and systemic treatment of patients at high risk for IFI, which we believe is critical to mitigate IFI-associated morbidity and mortality.
Case A
Was there an above the knee amputation: No
Was there a pelvic injury: Yes
Base deficit in theater: 6
Was a colostomy performed in theater: No
In theater Shock index: 1.0816
Units of Whole blood and PRBC transfused in theater: 8.00
Probability of Developing Invasive Fungal Infection
Case B
Was there an above the knee amputation: Yes
Base deficit in theater: 23
Was a colostomy performed in theater: Yes
Units of Whole blood and PRBC transfused in theater: 39.00
Case C
Massive Transfusion Protocol Tool
Protocol-Massive Transfusion Protocol (MTP)
Description-The decision to activate a massive transfusion protocol is both complex and time sensitive. It requires not only an urgent assessment of a critically injured patient's physiology but also must take into account issues of resource availability and utilization. Oftentimes, little empiric data is available rapidly enough to assist the bedside clinician and therefore this key decision is often left to the instincts of the treating team. Several published tools use manual calculations that are either too complex, making them of little use in real-time, or too simple, making them not accurate enough to be truly useful. Fortunately, technology allows us to bring sophisticated computers in the form of smart phones to the bedside to assist in these complex decisions. An mobile application designed to take simple physiologic data available to the clinician within minutes of patient arrival and create an extremely accurate prediction of the need for urgent massive transfusion has been designed using data from over 10 years of patient care in a busy urban trauma center. This application is currently being studied prospectively to understand if it will be a useful Clinical Decision Support tool.
Decompensation Tool
Status-In Production
Protocol-Decompensation (Decomp)
Description-The decompensation project leverages data acquired by and flowing from physiologic monitors to enable earlier detection and correction of clinically important decompensation. The goal is to create situation awareness for caregivers at the bedside of critically injured and ill surgical patients. The strategy is to develop and deploy a suite of real-time analytics running on high-performance computers that transform "big data" (physiologic monitors typically acquire 1000-4000 data per second per patient) into metrics and patient/population level displays. The architecture implemented in this project is flexible (meaning that several types of deterioration can be screened) and scalable (meaning that it can be replicated and applied to a single patient, unit, hospital or system of hospitals). The displays are web-based, meaning that the analytic displays will be visible on non-proprietary fixed or mobile devices
Open Abdomen Tool
Protocol-Damage Control Laparotomy - Open Abdomen
Description-The management of complex, contaminated abdominal wounds remains largely dependent upon the experience and judgment of the surgeon. This may result in either the premature closure of abdominal wounds destined for clinical failure, or performing additional procedures on wounds well beyond the window necessary for successful closure. There is therefore a need for a standardized process to determine the best method for achieving expedient and successful definitive closure of abdominal fascia. We are designing a Clinical Decision Support tool that will provide the necessary objective criteria for predicting successful abdominal closure after damage control laparotomy. This could potentially help us achieve delayed fascial closure during the same hospital admission when it can be accomplished safely, while avoiding the complications of multiple unsuccessful attempts to do the same. This might also optimize the chance of a successful planned staged ventral hernia. The ultimate goal is to improve outcomes while reducing costs for hospitals and victims of traumatic abdominal injury.
WOUNDx™
Status-Future
Protocol-Timing of debridement and closure (WounDX)
Description-Blast injuries and other combat-associated wounds present unique challenges to healthcare enterprises. We found that a comprehensive biological assessment, coupled with advanced mathematical techniques, can be used to generate a predictive model that may help surgeons improve outcomes by minimizing wound-related complications. This translates to shorter hospital stays, quicker rehabilitation, and lower costs. We then distilled the prognostic information into a Clinical Decision Support tool called WOUNDx™, which uses common inflammatory markers coupled with clinical observations to estimate the likelihood of wound failure in complex wounds. This highly predictive algorithm can help surgeons identify when to close or otherwise cover wounds in high risk military and civilian populations.