geneva, switzerland, 26-27 april 2012 piers on the move – phone oximetry for pre-eclampsia beth...
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Geneva, Switzerland, 26-27 April 2012
PIERS on the Move – Phone Oximetry for Pre-Eclampsia
Beth Payne Guy DumontPhD Candidate Professor [email protected] [email protected]
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