geneva, switzerland, 26-27 april 2012 piers on the move – phone oximetry for pre-eclampsia beth...

Geneva, Switzerland, 26-27 April 2012

PIERS on the Move – Phone Oximetry for Pre-Eclampsia

Beth Payne Guy DumontPhD Candidate Professor bpayne@cw.bc.ca guyd@ece.ubc.ca

University of British ColumbiaVancouver, BC, Canada

Joint ITU-WHO Workshop on e-Health Standards and Interoperability

(Geneva, Switzerland, 26-27 April 2012)

Pre-eclampsia

Hypertensive disorder of pregnancy with only cure being delivery of the placenta63,000 – 76,000 maternal deaths annually500,000 perinatal deaths annually>99% of these deaths in LMICsDeaths a result of delays in triage, transport and treatment

The PIERS models

Multivariate prognostic models for prediction of adverse maternal outcomes within 48hr – 7 days of diagnosis with pre-eclampsia

RationaleIdentify individual women at greatest (and least) risk in order to guide care (triage, transport, treatment)

von Dadelszen et al. Lancet 2011

The fullPIERS model

The miniPIERS model

• Simplified version of the PIERS model for use in low-resourced settings

• Allows task-shifting of care to reduce delays

von Dadelszen et al. Lancet 2011

Predictors of adverse maternal outcome

– GA– Chest pain/ dyspnoea

– SpO2

– Platelet count– Creatinine– AST

Prognosis: The PIERS Model

Millman et al. J Obstet Gynaecol Can 2011

Predictors of adverse maternal outcome

– GA– Chest pain/ dyspnoea

– SpOSpO22

– Platelet count– Creatinine– AST

The PIERS Model

AUC ROC of SpO2 as a predictor of any adverse maternal outcome within 48hrs of eligibility. (AUC ROC 0.71 [95% CI 0.65, 0.77])

What is pulse oximetry?

Equipmentexplained.comEquipmentexplained.com

What is pulse oximetery?

Equipmentexplained.comEquipmentexplained.com

The Phone Oximeter

12

Validation

• BC Childrens Hospital, Vancouver• High Satisfaction (83%)

• Mulago Hospital, Uganda• High Satisfaction (78%)

Triage Transportation Treatment

PIERS on the MovePIERS on the Move

The Problem…

?

$$$$ $

Capillary refill time

Respiratory Interaction

Thoracic Pressure Cardiac Output

HR

(Sinus Arrhythmia)

Pulse Strength

During Spontaneous Inspiration…

Respiratory Induced Intensity Variation (V)

Heart

Rate (Hz)

Amplitude

Time (s)

Frequency

(RIIV) (HR)

Summary

The goal of the PIERS project is to develop and validate simple outcome prediction tools for use in women with pre-eclampsiaPrediction modelling allows creation of complex decision support tools that have the potential to improve care of women and babies

Thank You!

Pediatric Anesthesia Research Team

http://part.cfri.ca

Electrical and Computer Engineering in Medicine

http://ecem.ece.ubc.ca

The Phone Oximeter

http://www.phoneoximeter.org