Abstract
Patient-controlled epidural analgesia (PCEA) was used in many patients receiving orthopedic surgery to reduce postoperative pain but is accompanied with certain incidence of vomiting. Predictions of the vomiting event, however, were addressed by only a few authors using logistic regression (LR) models. Artificial neural networks (ANN) are pattern-recognition tools that can be used to detect complex patterns within data sets. The purpose of this study was to develop the ANN based predictive model to identify patients with high risk of vomiting during PCEA used. From January to March 2007, the PCEA records of 195 patients receiving PCEA after orthopedic surgery were used to develop the two predicting models. The ANN model had a largest area under curve (AUC) in receiver operating characteristic (ROC) curve. The areas under ROC curves of ANN and LR models were 0.900 and 0.761, respectively. The computer-based predictive model should be useful in increasing vigilance in those patients most at risk for vomiting while PCEA is used, allowing for patient-specific therapeutic intervention, or even in suggesting the use of alternative methods of analgesia.
Highlights
Vomiting is one of the most frequent adverse effects of patient-controlled epidural analgesia (PCEA) with reported incidence of 3.1 to 34% [1,2,3,4]
All patients were classified into vomiting and nonvomiting groups according to their response to PCEA
Since high quality PCEA has been playing an important role in postoperative orthopedic patient care, a good predicting tool to avoid complications, especially vomiting, is very important
Summary
Vomiting is one of the most frequent adverse effects of patient-controlled epidural analgesia (PCEA) with reported incidence of 3.1 to 34% [1,2,3,4]. The clinical importance of this side effect has been shown in several studies which proved that vomiting episodes clearly correlated patients’ satisfaction with PCEA and it can reduce the percentage of PCEA for use. Routine medications to prevent vomiting are not recommended for several reasons including potential side-effects of antiemetic drugs, lack of increased patient satisfaction, and economic reasons [5, 6]. Identification of patients with high risk of vomiting related to PCEA would be an important step in the rational selection of patientcontrolled epidural analgesia and adoption of therapeutic interventions. In recent years ANN has been widely applied in computeraided diagnosis [7, 8], outcome prediction [9, 10], and signal
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have