Reducing False Intracranial Pressure Alarms Using Morphological Waveform Features

False alarms produced by patient monitoring systems in intensive care units are a major issue that causes alarm fatigue, waste of human resources, and increased patient risks. While alarms are typically triggered by manually adjusted thresholds, the trend and patterns observed prior to threshold crossing are generally not used by current systems. This study introduces and evaluates, a smart alarm detection system for intracranial pressure signal (ICP) that is based on advanced pattern recognition methods. Models are trained in a supervised fashion from a comprehensive dataset of 4791 manually labeled alarm episodes extracted from 108 neurosurgical patients. The comparative analysis provided between spectral regression, kernel spectral regression, and support vector machines indicates the significant improvement of the proposed framework in detecting false ICP alarms in comparison to a threshold-based technique that is conventionally used. Another contribution of this work is to exploit an adaptive discretization to reduce the dimensionality of the input features. The resulting features lead to a decrease of 30% of false ICP alarms without compromising sensitivity.

[1]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[2]  S. Lawless Crying wolf: False alarms in a pediatric intensive care unit , 1994, Critical care medicine.

[3]  J. Edworthy,et al.  Are there too many alarms in the intensive care unit? An overview of the problems. , 1995, Journal of advanced nursing.

[4]  C. Tsien,et al.  Poor prognosis for existing monitors in the intensive care unit. , 1997, Critical care medicine.

[5]  M. Chambrin,et al.  Multicentric study of monitoring alarms in the adult intensive care unit (ICU): a descriptive analysis , 1999, Intensive Care Medicine.

[6]  R. G. Mark,et al.  Reduction of false arterial blood pressure alarms using signal quality assessement and relationships between the electrocardiogram and arterial blood pressure , 2004, Medical and Biological Engineering and Computing.

[7]  Craig B. Laramee,et al.  Intelligent Alarm Processing into Clinical Knowledge , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[8]  Jiawei Han,et al.  Spectral Regression for Efficient Regularized Subspace Learning , 2007, 2007 IEEE 11th International Conference on Computer Vision.

[9]  Wei-Pang Yang,et al.  A discretization algorithm based on Class-Attribute Contingency Coefficient , 2008, Inf. Sci..

[10]  Mohammed Saeed,et al.  Reducing false alarm rates for critical arrhythmias using the arterial blood pressure waveform , 2008, J. Biomed. Informatics.

[11]  Xiao Hu,et al.  Morphological Clustering and Analysis of Continuous Intracranial Pressure , 2009, IEEE Transactions on Biomedical Engineering.

[12]  U. Gather,et al.  Intensive care unit alarms—How many do we need?* , 2010, Critical care medicine.

[13]  Chih-Jen Lin,et al.  LIBSVM: A library for support vector machines , 2011, TIST.

[14]  Ricardo A. M. Valentim,et al.  A fuzzy model for processing and monitoring vital signs in ICU patients , 2011, Biomedical engineering online.

[15]  Xiao Hu,et al.  Bayesian tracking of intracranial pressure signal morphology , 2012, Artif. Intell. Medicine.

[16]  Xiao Hu,et al.  Intracranial hypertension prediction using extremely randomized decision trees. , 2012, Medical engineering & physics.