Emergency Department Blood Pressure Management in Type B Aortic Dissection: An Analysis with Machine Learning.
Background: Acute aortic dissections (AAD) have a high morbidity and mortality rate. Treatment for type B aortic dissection includes strict systolic blood pressure (SBP) and heart rate (HR) control per the American Heart Association (AHA) guidelines. However, predictors of successful emergency depar...
| Published in: | Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Vol. 26; no. 3; pp. 674 - 685 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
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Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
May2025
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=185930703&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 185930703 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1936900X 8B61 jtl: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health issn: 1936900X maglogo: N pubinfo: dt: May2025 vid: 26 iid: 3 pid: 29816 pub: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health place: Orange, California artinfo: ui: 185930703 185930703 185930703 10.5811/westjem.25005 185930703 ppf: 674 ppct: 11 formats: fmt: @attributes: type: P tig: atl: Emergency Department Blood Pressure Management in Type B Aortic Dissection: An Analysis with Machine Learning. aug: au: Chen, Nelson Downing, Jessica V. Epstein, Jacob Mudd, Samira Chan, Angie Kuppireddy, Sneha Tehrani, Roya Vashee, Isha Hart, Emily Esposito, Emily Chasm, Rose Tran, Quincy K. affil: University of Maryland School of Medicine, Baltimore, Maryland sug: subj: Emergency Service Blood Pressure Determination Methods Aortic Dissections Complications Machine Learning Heart Rate Evaluation Transfer, Discharge Human Male Female Middle Age Aged Aged, 80 and Over Retrospective Design Record Review Practice Guidelines Systolic Pressure Physiology Random Forest Decision Trees Adrenergic beta-Antagonists Therapeutic Use Vasodilator Agents Therapeutic Use Labetalol Therapeutic Use Pain Management Methods Morphine Administration and Dosage American Heart Association Hemodynamics Descriptive Statistics Data Analysis Software Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: Background: Acute aortic dissections (AAD) have a high morbidity and mortality rate. Treatment for type B aortic dissection includes strict systolic blood pressure (SBP) and heart rate (HR) control per the American Heart Association (AHA) guidelines. However, predictors of successful emergency department (ED) management of SBP have not been well studied. Methods: We retrospectively analyzed the records of adult patients presenting to any regional ED with type B AAD between 2017-2020 with initial SBP >120 mmHg and HR >60 beats per minute (bpm) and were subsequently transferred to our quaternary center. Primary outcome was SBP <120 mmHg based on both the 2010 and 2022 AHA guidelines and HR <60 bpm (based on the 2010 guideline), or HR <80 (2022 guideline). We used random forest (RF) algorithms, a machine-learning tool that uses clusters of decision trees to predict a categorical outcome, to identify predictors of achieving HR and SBP goals prior to ED departure, defined as the time point at which patients left the referring ED to come to our institution. Results: The analysis included 134 patients. At the time of ED departure, 26 (19%) had SBP <120 mmHg, 96 (67%) received anti-impulse therapy, and 40 (28%) received beta-blocker or vasodilator infusions specifically. The RF algorithm identified higher triage SBP and treatment with intravenous labetalol as the top predictors for SBP >120 mmHg at ED departure, contrary to AHA guidelines. Pain management with higher total morphine equivalent unit, as well as shorter time to computed tomography as predictors for HR <60 bpm and <80 bpm, were in concert with AHA guidelines. Conclusion: Many patients with type B AAD did not achieve hemodynamic parameters in line with 2010 or 2022 AHA guidelines while being in the ED prior to transferring to a quaternary care center for further evaluation and management. Patients with higher heart rate and systolic blood pressure on ED arrival were less likely to achieve goals at the time of departure from the referring EDs. Those receiving more pain medications prior to transfer were more likely to meet certain AHA goals. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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