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Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage.

Publication ,  Journal Article
Klumpner, TT; Kountanis, JA; Meyer, SR; Ortwine, J; Bauer, ME; Carver, A; Piehl, AM; Smith, R; Mentz, G; Tremper, KK
Published in: Anesth Analg
September 2020

BACKGROUND: A leading cause of preventable maternal death is related to delayed response to clinical warning signs. Electronic surveillance systems may improve detection of maternal morbidity with automated notifications. This retrospective observational study evaluates the ability of an automated surveillance system and the Maternal Early Warning Criteria (MEWC) to detect severely morbid postpartum hemorrhage (sPPH) after delivery. METHODS: The electronic health records of adult obstetric patients of any gestational age delivering between April 1, 2017 and December 1, 2018 were queried to identify scheduled or unscheduled vaginal or cesarean deliveries. Deliveries complicated by sPPH were identified and defined by operative management of postpartum hemorrhage, transfusion of ≥4 units of packed red blood cells (pRBCs), ≥2 units of pRBCs and ≥2 units of fresh-frozen plasma, transfusion with >1 dose of furosemide, or transfer to the intensive care unit. The test characteristics of automated pages and the MEWC for identification of sPPH 24 hours after delivery were determined and compared using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and their 95% confidence intervals (CIs). McNemar test was used to compare these estimates for both early warning systems. RESULTS: The average age at admission was 30.7 years (standard deviation [SD] = 5.1 years), mean gestational age 38 weeks 4 days, and cesarean delivery accounted for 30.0% of deliveries. Of 7853 deliveries, 120 (1.5%) were complicated by sPPH. The sensitivity of automated pages for sPPH within 24 hours of delivery was 60.8% (95% CI, 52.1-69.6), specificity 82.5% (95% CI, 81.7-83.4), PPV 5.1% (95% CI, 4.0-6.3), and NPV 99.3% (95% CI, 99.1-99.5). The test characteristics of the MEWC for sPPH were sensitivity 75.0% (95% CI, 67.3-82.7), specificity 66.3% (95% CI, 65.2-67.3), PPV 3.3% (95% CI, 2.7-4.0), and NPV 99.4% (95% CI, 99.2-99.6). There were 10 sPPH cases identified by automated pages, but not by the MEWC. Six of these cases were identified by a page for anemia, and 4 cases were the result of vital signs detected by the bedside monitor, but not recorded in the patient's medical record by the bedside nurse. Therefore, the combined sensitivity of the 2 systems was 83.3% (95% CI, 75.4-89.5). CONCLUSIONS: The automated system identified 10 of 120 deliveries complicated by sPPH not identified by the MEWC. Using an automated alerting system in combination with a labor and delivery unit's existing nursing-driven early warning system may improve detection of sPPH.

Duke Scholars

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 2020

Volume

131

Issue

3

Start / End Page

857 / 865

Location

United States

Related Subject Headings

  • Vital Signs
  • Time Factors
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Reproducibility of Results
  • Pregnancy
  • Predictive Value of Tests
  • Postpartum Period
 

Citation

APA
Chicago
ICMJE
MLA
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Klumpner, T. T., Kountanis, J. A., Meyer, S. R., Ortwine, J., Bauer, M. E., Carver, A., … Tremper, K. K. (2020). Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage. Anesth Analg, 131(3), 857–865. https://doi.org/10.1213/ANE.0000000000004605
Klumpner, Thomas T., Joanna A. Kountanis, Sean R. Meyer, Justin Ortwine, Melissa E. Bauer, Alissa Carver, Anne Marie Piehl, Roger Smith, Graciela Mentz, and Kevin K. Tremper. “Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage.Anesth Analg 131, no. 3 (September 2020): 857–65. https://doi.org/10.1213/ANE.0000000000004605.
Klumpner TT, Kountanis JA, Meyer SR, Ortwine J, Bauer ME, Carver A, et al. Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage. Anesth Analg. 2020 Sep;131(3):857–65.
Klumpner, Thomas T., et al. “Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage.Anesth Analg, vol. 131, no. 3, Sept. 2020, pp. 857–65. Pubmed, doi:10.1213/ANE.0000000000004605.
Klumpner TT, Kountanis JA, Meyer SR, Ortwine J, Bauer ME, Carver A, Piehl AM, Smith R, Mentz G, Tremper KK. Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage. Anesth Analg. 2020 Sep;131(3):857–865.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 2020

Volume

131

Issue

3

Start / End Page

857 / 865

Location

United States

Related Subject Headings

  • Vital Signs
  • Time Factors
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Reproducibility of Results
  • Pregnancy
  • Predictive Value of Tests
  • Postpartum Period