WO2010096247A1 - Protocole de thérapie configurable par utilisateur pour ischémie cardiaque aiguë - Google Patents

Protocole de thérapie configurable par utilisateur pour ischémie cardiaque aiguë Download PDF

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Publication number
WO2010096247A1
WO2010096247A1 PCT/US2010/022191 US2010022191W WO2010096247A1 WO 2010096247 A1 WO2010096247 A1 WO 2010096247A1 US 2010022191 W US2010022191 W US 2010022191W WO 2010096247 A1 WO2010096247 A1 WO 2010096247A1
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WIPO (PCT)
Prior art keywords
contraindications
thrombolytic
list
ecg
therapy
Prior art date
Application number
PCT/US2010/022191
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English (en)
Inventor
James M. Grady
William D Grube
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Koninklijke Philips Electronics, N.V.
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Filing date
Publication date
Application filed by Koninklijke Philips Electronics, N.V. filed Critical Koninklijke Philips Electronics, N.V.
Priority to PCT/US2010/034781 priority Critical patent/WO2011093919A1/fr
Publication of WO2010096247A1 publication Critical patent/WO2010096247A1/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/40—ICT specially adapted for the handling or processing of medical references relating to drugs, e.g. their side effects or intended usage
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients

Definitions

  • This invention relates to medical instruments which assist a physician in the delivery of therapy and, in particular, to a therapy guidance system which assists a physician in decisions concerning thrombolytic drug therapy for an ischemic patient.
  • the Philips HeartStart® MRx monitor/ defibrillator available from Philips Healthcare of Andover, MA, is a portable medical instrument capable of monitoring various bodily functions relating to cardiac care and is capable of providing electrotherapy such as defibrillation and pacing when needed.
  • the MRx monitor/defibrillator is also capable of assisting medical personnel in the decision of whether to prescribe thrombolytic drug therapy. This is done through an analysis package included in the monitor/defibrillator which is known as the Thrombolytic Predictive Instrument (TPI) originally developed by Dr. H. P. Selker. TPI analysis is described in U.S. Patent 4,998,535 (Selker et al .
  • the TPI analysis protocol uses the patient's ECG data, the time since the onset of ischemic symptoms, patient blood pressure, age, gender, weight, history of hypertension, and history of diabetes to calculate the following predicted patient outcomes: • 30 day mortality rate with and without thrombolytic therapy;
  • the present invention enhances this guidance by prompting the clinician through contraindications to thrombolytic therapy that should be considered when deciding whether to prescribe the therapy.
  • a therapy guidance system allows a list of thrombolytic therapy contraindications to be edited and configured as desired by a user and stored in the system.
  • the custom-tailored list of contraindications is presented to a user who is considering prescribing thrombolytic therapy for a patient.
  • the contraindications are presented as a sequence of yes/no questions, and the user responds to each question as to whether it is present, absent, or its presence is unknown.
  • the contraindications are presented in conjunction with execution of a TPI analysis algorithm.
  • the clinician's responses to the contraindication questions are stored in the patient data which can be displayed, printed, exported for review, or forwarded to a receiving care facility.
  • An implementation of the present invention presents the physician with key treatment protocol considerations when treating a patient.
  • thrombolytic Predictive Instrument 12 -lead ECG analysis a Thrombolytic Predictive Instrument 12 -lead ECG analysis.
  • the execution of the protocol presents questions to the clinician on the system display, to which the clinician responds by entering requested patient information.
  • the present invention may be implemented as a software program in a monitor/defibrillator such as that shown in FIGURE 1 below.
  • the user's protocol is stored on a memory device of the instrument's internal file system and is presented on the display when requested by the clinician or when the programmed workflow calls for its display.
  • Input devices such as a keypad and other controls capture the clinician's inputs and stores the results in an internal report file.
  • FIGURE 1 illustrates in block diagram form a defibrillator/monitor constructed in accordance with the principles of the present invention.
  • FIGURE 2 is a block diagram of major subsystems of an ECG signal acquisition system constructed in accordance with the principles of the present invention.
  • FIGURE 3 is a block diagram of the processing module of the ECG system of FIGURE 2.
  • FIGURE 4 illustrates the processing of ECG trace data to provide information about the heartbeat and its rhythm.
  • FIGURES 5 illustrates the measurement of different parameters of an ECG trace.
  • FIGURES 6a and 6b illustrate the segments of a normal ECG signal and an ECG signal exhibiting an elevated ST segment level.
  • FIGURE 7 is a data flow diagram showing the development of standard ECG analysis, ACI-TIPI analysis, and thrombolytic predictive instrument (TPI) analysis and reporting.
  • FIGURE 8 is a flowchart of an implementation of conditional ACI-TIPI analysis in accordance with the principles of the present invention.
  • FIGURE 9 illustrates a report screen of an ECG analysis system when standard ECG analysis indicates acute MI.
  • FIGURE 10 illustrates an ECG strip with a standard analysis report indicating acute MI.
  • FIGURE 11 illustrates the report screen when standard ECG analysis is followed by ACI-TIPI analysis.
  • FIGURE 12 illustrates the report screen when the probability of acute MI exceeds a threshold level.
  • FIGURES 13a and 13b illustrate ECG strips which present a standard interpretation and ACI-TIPI statements and recommendation.
  • FIGURE 14 illustrates the report screen when a standard ECG interpretation and ACI-TIPI analysis indicate conflicting results.
  • FIGURE 15 illustrates prompts on the screen of an ECG analysis system which prompt a user to input data needed for TPI analysis.
  • FIGURE 16 illustrates screen prompts for a user to consider contraindications to thrombolytic drug treatment .
  • FIGURES 17a-17c illustrate an ECG strip with a printed report of TPI analysis results including the user's inputs to contraindication prompts.
  • FIGURE 1 a patient monitor/defibrillator constructed in accordance with the principles of the present invention is shown in block diagram form.
  • the instrument shown in FIGURE 1 is commercially available from Philips Healthcare of Andover, MA as the MRx defibrillator/monitor and is capable of performing defibrillation of a patient who is experiencing ventricular fibrillation. It is also capable of performing ECG monitoring including the cardiac monitoring necessary for automatic defibrillation analysis and myocardial infarction decision-making.
  • the illustrated monitor is also capable of SpO 2 oxygen sensing, noninvasive blood pressure monitoring, and end tidal CO 2 monitoring. Other functions such as invasive blood pressure monitoring and patient temperature monitoring may also be found in such a multi-functional instrument.
  • the monitor/defibrillator has a plurality of patient front-ends, which are input circuitry for the sensors attached to the patient.
  • This circuitry includes conventional sensing and amplification circuitry for ECG electrodes, for oxygen sensors, for pressure sensing and for carbon dioxide sensing, among others.
  • the information received by the patient sensors and the front-end circuitry 10 is digitized by front-end A/D converters 12 if the signals are not already in digital form.
  • the digitized information is coupled to processing circuitry of the instrument by a communications bus 60 which connects data between the various modules of the instrument .
  • the monitor/defibrillator instrument includes high voltage circuitry 16 for defibrillator operation.
  • the high voltage circuitry produces the high voltage pulses necessary for defibrillation which are connected at the appropriate times by switching logic 14 to defibrillator electrodes coupled to the patient.
  • This circuitry provides the high voltage shocks needed to disrupt the ventricular fibrillation and return the heart to a normal rhythm.
  • the shock level and waveform delivered for defibrillation can be automatically calculated by a processor in the monitor or can be manually set with the controls of the instrument by an experienced medical technician or physician.
  • Power for the modules within the monitor/ defibrillator instrument is distributed by power handling circuits 20.
  • the power handling circuits 20 will distribute power from batteries 22, from an AC supply 24, or from a DC supply 26.
  • the AC and DC supplies are also coupled to circuitry which charges the batteries when the monitor is powered from these external power sources.
  • the information obtained by the instrument may be sent to other instruments or locations by communications circuitry 30.
  • This may include a network connection, an RS232 connection, and/or a wireless connection (e.g. Bluetooth, WiFi or infrared, etc.)
  • the monitor/defibrillator instrument is operated and adjusted by means of a keypad and controls 32.
  • the keypad is a membrane keypad providing integrity against environmental conditions. Controls such as an on/off switch, power level and shock delivery controls for defibrillation, a printer, and other functions may also be provided.
  • the monitor/defibrillator is operated under control of a central processing unit (CPU) 40.
  • the CPU runs software stored on a read-only memory (ROM) 38, including standard ECG, ACI-TIPI, and TPI analysis software. Flash ROM is also provided for the control of feature setups and new or special capabilities such as waveform information.
  • Removable memory 36 is provided for storage of information generated during a patient episode.
  • Patient information such as cardiac waveforms before and after defibrillation and ECG analysis reports are also stored on the removable memory 36, which can be removed and given to a subsequent care-giver for review, record-keeping, and subsequent diagnosis.
  • the removable memory 36 can also record voice information from a care-giver speaking into a microphone 48.
  • Beepers 34 are used to drive a solid-state sound source that produces short "chirping" sounds. These sounds indicate that the instrument's resident self- test has detected a low battery level or a malfunction in a patient-critical circuit group.
  • Tones 46 are produced by the software and then used to drive the speaker 42. This capability is used during certain monitoring functions such as in the production of a short tone in response to each heart cycle. Combinations of tones are used to issue audible alerts and alarms when a patient's vital measurements fall outside the alarm limits selected.
  • the speaker 42 can reproduce pre-recorded voice instructions and information stored and reproduced from voice-out circuitry 44.
  • a display 50 is provided for the display of patient information such as physiological measurement parameters and waveforms and the display screens discussed below.
  • the display 50 also displays input data and the results of ECG analysis, predictive ACI-TIPI ischemia analysis and TPI analysis in accordance with the present invention.
  • An ECG strip printer 54 prints ECG output information including acquired ECG traces and the results of ECG analysis, ACI-TIPI analysis, and TPI analysis .
  • the patient's ECG data is acquired by a 12 -lead ECG system coupled to the front-end circuitry 10 of the MRx defibrillator/ monitor.
  • the ECG data is applied as input data to a standard ECG analysis, the ACI- TIPI ischemia analysis, and TPI analysis software programs.
  • the standard ECG analysis software provides an indication of an abnormal condition such as acute MI and the ACI-TIPI program calculates the predicted probability of acute cardiac ischemia from the ECG data.
  • the cardiac analysis system would present a full ACI-TIPI report which includes the predicted probability of acute cardiac ischemia and a list of criteria that were used in the calculation of the probability.
  • the disadvantage of this approach is that for small, pre-hospital devices, the screen size may not allow display of the full report, or the user must wait for the report to be printed.
  • the MRx system described herein can be configured to display the predicted probability of ACI with the standard ECG interpretation report.
  • the predictive value is greater than or equal to a threshold pre-set by the user, the value is highlighted with a colored background, drawing the attention of the clinician to the important finding.
  • the advantage of this approach is that the clinician is more likely to immediately see the result and identify patients that need immediate intervention.
  • the user of an MRx system with the ACI-TIPI option can configure the system so that the ACI-TIPI analysis is performed on the 12 -lead ECG data that is acquired.
  • the user can configure an "ACI Threshold" setting, above which value the ACI prediction is highlighted.
  • the MRx system is configured to perform ACI- TIPI analysis of a 12-lead ECG, then the Predicted Probability of Acute Cardiac Ischemia is displayed at the bottom of the MRx display before the printing of the report has completed. If the value of the predicted probability is less than the ACI threshold set previously by the user, the predicted probability is displayed with white text on a black background. If the predicted probability is greater than the ACI threshold, the predicted probability is highlighted by displaying it with white text on a red background. This is an unambiguous indication that the patient needs immediate intervention, such as an emergency catheterization.
  • the report can be printed, exported from the device for later review by transport of the removable memory 36, or transmitted by network or Bluetooth Communications 30 and cell phone to a receiving care facility to prepare for treating an incoming patient.
  • FIGURE 2 an ECG signal acquisition system suitable for use in an implementation of the present invention is shown in block diagram form.
  • a plurality of electrodes 70 are provided for attaching to the skin of a patient.
  • the electrodes are disposable conductors with a conductive adhesive gel surface that sticks to the skin. Each conductor has a snap or clip that snaps or clips onto an electrode wire of the ECG system.
  • the electrodes 70 are coupled to an ECG acquisition module 62 of the acquisition system that preconditions the signals received by the electrodes.
  • the electrode signals are coupled to an ECG processing module 66, generally by means of an electrical isolation arrangement 64 that protects the patient from shock hazards and also protects the ECG system when the patient is undergoing defibrillation, for instance.
  • Optical isolators are generally used for electrical isolation.
  • the processed ECG information is then displayed on an image display or printed in an ECG report by an output device 68.
  • FIGURE 3 is a block diagram of the analysis portion of a typical ECG analysis system.
  • a pace pulse detector 72 identifies and sets aside electrical spikes and other electrical abnormalities produced by a pacemaker for patients who are wearing one.
  • a QRS detector 74 detects the dominant pulse of the electrical traces.
  • FIGURE 6a illustrates a typical normal ECG trace, where it is seen that the Q-R-S segments delineate the major electrical pulse of the trace, which is the pulse that stimulates a contraction of the left ventricle. Delineation of the QRS complex forms the basis for detecting the lesser perturbations of the trace, which is performed by the waveform segmenter 76.
  • the waveform segmenter delineates the full sequence of trace segments including the P wave and the Q to U segments of the ECG trace including the S-T segment.
  • a beat classifier 78 compares each new beat with previous beats and classifies beats as normal (regular) or abnormal (irregular) for the individual undergoing diagnosis.
  • the classification of the beats enables an average beat analyzer 84 to define the characteristics of a normal heartbeat and the amplitudes and segment durations of an average beat are measured at 86.
  • the beat classifications are used to determine the heart rhythm at 88.
  • FIGURES 4 and 5 are functional illustrations of some of this ECG trace processing.
  • the beat classifier 78 compares the various beat characteristics and has classified some of the beats as normal (N*, 0) . For example, all of the beats from leads V5 and V6 have been classified as normal.
  • the other four leads contain a beat exhibiting the characteristics of premature ventricular contraction (PVC, 1) in this example.
  • PVC premature ventricular contraction
  • the ECG system aggregates the characteristics of the normal beats, excludes characteristics of the abnormal beats, aligns the beats in time and averages them to produce an average beat.
  • the traces at 94 illustrate the traces of an average beat for the six leads shown in this example.
  • the average beat traces 94 of the six leads are measured for various characteristics shown at 96, such as the amplitudes and durations of the Q wave, the R wave, and the T wave and inter-wave intervals such as QRS, ST, and QT.
  • the measurements are illustrated as recorded in a measurement matrix 98 for the six leads of this example.
  • the ECG waves and their measurements can be sent to an offline workstation with a report generation package for the production of a report on the patient's ECG waveforms.
  • the MRx defibrillator/monitor has its own onboard ECG reporting package.
  • ECG lead signals are analyzed for particular patterns of elevated and depressed ST segments which relate to stenoses of specific coronary arteries and branches which may have caused an infarction.
  • the signal level of the ST segment 80 is at or very close to the nominal baseline of the ECG trace.
  • the ST segment 82 for a lead in proximity to the artery will be highly elevated as shown in FIGURE 6b, where the dashed line indicates the nominal baseline of the trace.
  • the ST segment can be elevated 100 ⁇ volts or more.
  • FIGURE 7 is a data flow diagram showing the development of standard ECG analysis, ACI-TIPI analysis, and thrombolytic predictive instrument (TPI) analysis and reporting by the MRx defibrillator/monitor .
  • the system acquires ECG data, from which measurements are made at 102 as previously described. These measurements of the ECG signal are stored in the measurement matrix and used at 104 to generate standard ECG interpretive statements.
  • ECG measurements are also used in conjunction with other inputs such as patient sex, age, and chest pain symptom information at 106 to generate ACI-TIPI statements for the ECG report.
  • the ECG measurements are further used with patient sex, age and weight data and other user inputs such as time since the onset of symptoms, blood pressure, history of hypertension, and history of diabetes at 108 to generate TPI statements.
  • FIGURE 8 is a flowchart showing the sequencing of various ECG analyses.
  • the ECG analysis system acquires ten seconds of a patient's ECG data. This data is used at 114 to make the ECG measurements as described above.
  • the system performs the standard ECG analysis including the generation of the standard interpretations. Standard ECG analysis algorithms are described, for example, in the Philips DXL ECG Algorithm Physician' s Guide, published by Philips Healthcare of Andover, MA (2009) , which explains the diagnoses resulting from various ECG characteristics.
  • the system checks to see whether the user has set the system to perform an advanced measurement mode of analysis. If no advanced mode has been set, the sequence at 126 goes to 156 to display and print the ECG report.
  • the ECG analysis system has been set to always run ACI-TIPI analysis.
  • the system will generate ACI-TIPI interpretation statements at 130.
  • the ACI-TIPI analysis aids a physician's diagnosis of indications of angina pectoris and acute myocardial infarction by computing a predicted probability of acute MI in the form of a 0-100% percentage score.
  • This score is generated by a formula based on weighted values for the patient's age, sex, chest pain status, and selected ECG measurements (significant Q waves, ST segment elevation or depression, and T wave elevation or inversion.
  • An equation uses these measurements and characteristics to compute the predicted probability of acute MI. Further details of this equation and its computations can be found in the Predictive Instruments Physician' s Guide, published by Philips Healthcare of Andover, MA (2002) .
  • the user may also set the system to run TPI analysis. If this setting has been selected, the system will generate ACI-TIPI interpretation statements at 140 and then perform TPI screening analysis at 142 to assess whether the presented ECG is a candidate for TPI analysis. If this assessment at 132 is affirmative, the system will prompt the user to input the TPI inputs at 134, as described above in FIGURE 7. In accordance with the principles of the present invention, the system may also solicit thrombolytic therapy contraindications from the user at 136. The TPI analysis will then generate TPI interpretation statements at 138.
  • the TPI analysis computes predicted probabilities of patient outcome and risk associated with thrombolytic therapy in the form of a 0-100% percentage score.
  • the score is generated using a formula based on weighted values for the patient's age, gender, weight, blood pressure, time since the onset of ischemic symptoms, medical history, and ECG waveform measurements. Further details of TPI analysis may be found in the Predictive Instruments Physician' s Guide referenced above.
  • the system When the user has set the system for conditional ACI-TIPI analysis, the system first looks at the standard ECG analysis at 120 to see if the ECG was found to be normal. If the answer is "no", then the system checks at 122 whether the results of the standard analysis found acute MI to be indicated. If the answer to this inquiry is also "no", then ACI- TIPI analysis is performed at 124.
  • FIGURE 9 illustrates a report screen 170 that is produced when the standard ECG interpretation results in a definitive diagnosis of acute MI.
  • FIGURE 11 illustrates a report screen 174 in another case where the conditional ACI-TIPI analysis path has been followed.
  • the standard analysis has found the ECG to be abnormal (120 is “no"), but the data is insufficient for the standard analysis to definitively determine acute MI (122 is “no") .
  • the standard analysis is reporting "Borderline ST elevation” at the top of the screen and a final determination of "BORDERLINE ECG” .
  • the ACI-TIPI analysis is run at 124 and in this case the ACI-TIPI analysis has found a "Predicted Probability of Acute Ischemia 60%" as shown at the bottom of the screen. The clinician is thus given a definitive indication that acute ischemia may be present.
  • FIGURES 13a and 13b show segments of the printed report for this patient, with segment 180 in FIGURE 13a illustrating the printed report from the standard ECG analysis and segment 182 in FIGURE 13b illustrating the printed report of the ACI-TIPI analysis, including the patient characteristics which were weighed in making the probability determination.
  • FIGURE 12 shows an exemplary report screen 176 which may result from following any of the ACI-TIPI analysis paths in FIGURE 8.
  • the user had set a threshold of a predicted probability of 75% above which the ECG analysis system will highlight the probability finding. It is seen that the report screen 176 is reporting a predicted probability of acute ischemia of 82%, which is in excess of this preset threshold.
  • boxes 150 and 154 cause the final diagnosis to be highlighted to draw the attention of the physician, and the predicted probability and diagnosis of acute MI both appear against a highlighted background 178.
  • FIGURE 14 shows an exemplary report screen 182 which illustrates the problem that can arise when the ACI-TIPI analysis is run as a mandatory part of the sequence.
  • the standard ECG analysis has found the ECG to be abnormal and has determined that "Acute MI" is present, as shown at the bottom of the screen.
  • the ACI-TIPI has also been run and results in a predicted probability of acute ischemia of 37%. Now the clinician is presented with a quandary in how to triage the patient: is acute MI present or not?
  • the conditional ACI-TIPI analysis path which runs the ACI-TIPI analysis only when the standard analysis is inconclusive, will prevent this problem from arising.
  • the ECG analysis sequence of FIGURE 8 may also run thrombolytic predictive instrument (TPI) analysis to assist a physician in assessing patient risk and outcome when treated with thrombolytic therapy such as blood thinners.
  • TPI thrombolytic predictive instrument
  • Certain information about the patient is used by the TPI analysis as shown in FIGURE 7 and described above in conjunction with FIGURE 8.
  • This patient information is input into the ECG analysis system by the user as stated in box 134 of FIGURE 8 and illustrated by display screen 190 of FIGURE 15, which shows that this patient data has been entered into the system .
  • the user is also presented with contraindications to thrombolytic therapy to consider before prescribing the therapy.
  • FIGURE 16 shows a list of nine such factors, including one of which is highlighted for response by the user.
  • the list of contraindication factors is first presented to the user, all of the answers are shown as “unknown.”
  • the user can see at a glance which questions in the list remain to be answered by "yes” or "no" when the user has that information.
  • the list of contraindications is programmable by a user.
  • a medical institution may want its attending physicians to only consider certain contraindications, for example, or may want its physicians to always consider specific contraindications.
  • These contraindications can be selectively programmed into the ECG analysis system list of FIGURE 16 so that an attending physician is always presented with the contraindications to be considered at the institution.
  • the system comes from the manufacturer with a default list of contraindication which is : 1.
  • a user who wants to edit the list displays the current list of contraindication as shown in FIGURE 16 and clicks on an edit button on the screen, one of controls 32 of FIGURE 1, to enter a special configuration mode.
  • the user After editing the list with one or more controls 32 (e.g., a keyboard) to contain the desired contraindications, the user saves the edited list and exits the configuration mode. Thereafter the user is presented with the customized contraindications each time the contraindications screen is used. Users may alter, delete, replace or supplement any of the default contraindications with other contraindication factors they may favor, such as : • History of stroke or brain surgery
  • Anticoagulant medications (Coumadin, warfarin, heparin)
  • a physician or medical institution may thus customize the list of contraindication considerations to conform with the factors they want to consider for the best and most appropriate patient care.
  • FIGURES 17a, 17b, and 17b illustrate three ECG strip segments on which TPI results are printed.
  • the segment 194 in FIGURE 17a shows the patient data which was input for the TPI analysis.
  • Segment 196 in FIGURE 17b shows the results of TPI analysis as TPI statements, the predicted outcomes when treating this patient with thrombolytic drugs.
  • Segment 198 of FIGURE 17c shows the contraindication factors considered by the physician and the answers input into the system in response to the contraindication questions .

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  • General Health & Medical Sciences (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Medicinal Chemistry (AREA)
  • Epidemiology (AREA)
  • Chemical & Material Sciences (AREA)
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  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

L'invention porte sur un système de guidage de thérapie qui aide un médecin dans des décisions concernant une thérapie thrombolytique par médicament. Un protocole d'instrument prédictif thrombolytique (TPI) est sensible à des données d'ECG de patient et à des données de certaines caractéristiques du patient telles que l'âge, le sexe, les antécédents médicaux, etc., et prédit les risques potentiels et les résultats de thérapie thrombolytique par médicament pour un patient atteint d'une ischémie. Conjointement avec le TPI, le système affiche une liste de contre-indications qui devraient être prises en considération par un médecin avant prescription d'une thérapie thrombolytique par médicament. La liste des contre-indications peut être éditée et personnalisée par l'utilisateur avant déploiement du système. De préférence, les contre-indications se trouvent sous la forme de questions ouvertes/fermées auxquelles doit répondre le médecin. La liste des contre-indications et des réponses entrées sont imprimées et/ou affichées dans un rapport d'analyse d'ECG.
PCT/US2010/022191 2009-02-18 2010-01-27 Protocole de thérapie configurable par utilisateur pour ischémie cardiaque aiguë WO2010096247A1 (fr)

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Citations (5)

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Publication number Priority date Publication date Assignee Title
US20040034284A1 (en) * 2002-04-10 2004-02-19 Aversano Thomas R. Patient initiated emergency response system
US20050004485A1 (en) * 2003-05-19 2005-01-06 Ischemia Technologies, Inc. Apparatus and method for risk stratification of patients with chest pain of suspected cardiac origin
US20060161459A9 (en) * 1999-06-23 2006-07-20 Visicu, Inc. System and method for displaying a health status of hospitalized patients
US20070129611A1 (en) * 2005-12-06 2007-06-07 University Of North Texas Health Science Center At Fort Worth System, Method and Apparatus for Assessing Menopausal or Post-Hysterectomy Symptoms
US20070232946A1 (en) * 2006-03-31 2007-10-04 Koninklijke Philips Electronics N.V. Ecg lead misplacement detection and correction

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060161459A9 (en) * 1999-06-23 2006-07-20 Visicu, Inc. System and method for displaying a health status of hospitalized patients
US20040034284A1 (en) * 2002-04-10 2004-02-19 Aversano Thomas R. Patient initiated emergency response system
US20050004485A1 (en) * 2003-05-19 2005-01-06 Ischemia Technologies, Inc. Apparatus and method for risk stratification of patients with chest pain of suspected cardiac origin
US20070129611A1 (en) * 2005-12-06 2007-06-07 University Of North Texas Health Science Center At Fort Worth System, Method and Apparatus for Assessing Menopausal or Post-Hysterectomy Symptoms
US20070232946A1 (en) * 2006-03-31 2007-10-04 Koninklijke Philips Electronics N.V. Ecg lead misplacement detection and correction

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