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PubMed2004

Economic analysis of the diagnosis of smear-negative pulmonary tuberculosis in South Africa: incorporation of a new rapid test, FASTPlaqueTB, into the diagnostic algorithm.

OBJECTIVE: To compare the cost-effectiveness of three diagnostic algorithms incorporating a new rapid test, FASTPlaqueTB, with the current National TB Control Programme (NTCP) algorithm for diagnosis of pulmonary tuberculosis in new smear-negative suspects in South Africa. DESIGN: A model of the outcome of patients screened using each diagnostic algorithm was established using published costs and performance data for each component of the algorithm. Direct health care provider costs associated with provision of each diagnostic strategy were determined. Overall performance, total cost, speed and accuracy of diagnosis were estimated for screening 1000 new TB suspects using each algorithm. RESULTS: The use of FASTPlaqueTB and culture algorithms enabled 28% more smear-negative TB patients to be diagnosed overall and was cheaper to implement than the NTCP algorithm (18,312-18,581 US dollars compared with 20,079 dollars). Fewer clinic visits were required to establish a diagnosis, reducing clinic workload and patient costs. FASTPlaqueTB enabled rapid and specific diagnosis of at least 50% of smear-negative TB patients within 2 days. CONCLUSIONS: The use of FASTPlaqueTB can assist in improving existing case detection strategies and may be cost-effectively integrated into the current diagnostic infrastructure, offering patients more rapid and reliable diagnosis whilst reducing the overall cost.

Algorithms↗

PubMed2004

Application of a diagnostic algorithm for inherited thrombocytopenias to 46 consecutive patients.

BACKGROUND AND OBJECTIVES: The Italian Gruppo di Studio delle Piastrine recently developed a diagnostic algorithm to assist clinicians in the diagnosis of inherited thrombocytopenias. This algorithm is based on the simplest possible diagnostic investigations and can also be used in centers that are not highly specialized. The aim of the present study was to validate this diagnostic algorithm by applying it to a case series of genetic thrombocytopenias. DESIGN AND METHODS: The diagnostic algorithm was applied retrospectively to 46 consecutive patients observed during the last five years at a single institution. Twenty-eight were affected by defined illnesses or their variants, while 18 had a disorder that did not fit the criteria for any known genetic thrombocytopenia. The study was based on the evaluation of clinical records and laboratory tests. RESULTS: The diagnostic algorithm recognized: 4 homozygous and 4 heterozygous Bernard-Soulier syndromes, 11 MYH9-related diseases, one von WillebrandOs disease type 2B, one gray platelet syndrome and one X-linked thrombocytopenia with thalassemia. Moreover, it identified 4 patients with the clinical and laboratory features of heterozygous Bernard-Soulier syndrome not caused by mutations in the coding region of the GPIbalpha, GPIbbeta, GPIX or GPV genes, and two patients with the clinical phenotype of MYH9-related disease but without MYH9 mutations. Since the diagnostic flow chart did not allow prompt recognition of two subjects with MYH9-related disease, we introduced a small change to the previously proposed flow chart to obviate this defect. INTERPRETATION AND CONCLUSIONS: The diagnostic algorithm correctly diagnosed 26 of 28 patients with known disorders or phenotypic variants of known disorders. By a simple modification of the investigation sequence, its sensitivity reached 100%. The algorithm also identified 18 patients with new, as yet uncharacterized forms of genetic thrombocytopenia.

Algorithms↗

PubMed2004

Improvement of algorithm for quantification of regional myocardial blood flow using 15O-water with PET.

UNLABELLED: (15)O-Water and dynamic PET allow noninvasive quantification of myocardial blood flow (MBF). However, complicated image analyzing procedures are required, which may limit the practicality of this approach. We have designed a new practical algorithm, which allows stable, rapid, and automated quantification of regional MBF (rMBF) using (15)O-water PET. We designed an algorithm for setting the 3-dimensional (3D) region of interest (ROI) of the whole myocardium semiautomatically. Subsequently, a uniform input function was calculated for each subject using a time-activity curve in the 3D whole myocardial ROI. The uniform input function allows the mathematically simple and robust algorithm to estimate rMBF. METHODS: Thirty-six volunteers were used in the static (15)O-CO and dynamic (15)O-water PET studies. To evaluate the reproducibility of the estimates, a repeated (15)O-water scan was obtained under resting condition. In addition, to evaluate the stability of the new algorithm in the hyperemic state, a (15)O-water scan was obtained with adenosine triphosphate. This algorithm includes a procedure for positioning a 3D ROI of the whole myocardium from 3D images and dividing it into 16 segments. Subsequently, the uniform input function was calculated using time-activity curves in the whole myocardial ROI and in the LV ROI. The uniform input function allowed this simple and robust algorithm to estimate the rMBF, perfusable tissue fraction (PTF), and spillover fraction (Va) according to a single tissue compartment model. These estimates were compared with those calculated using the original method. A simulation study was performed to compare the effects of errors in PTF or Va on the MBF using the 2 methods. RESULTS: The average operating time for positioning a whole myocardial ROI and 16 regional myocardial ROIs was <5 min. The new method yielded less deviation in rMBF (0.876 +/- 0.177 mL/min/g, coefficient of variation [CV] = 20.2%, n = 576) than those with the traditional method (0.898 +/- 0.271 mL/min/g, CV = 30.1%, n = 576) (P < 0.01). In the hyperemic state, the new method yielded less deviation in rMBF (3.890 +/- 1.250 mL/min/g, CV = 32.1%) than those with the traditional method (3.962 +/- 1.762 mL/min/g, CV = 44.4%) (P < 0.05). This method yielded significantly higher reproducibility of rMBF (r = 0.806, n = 576) than the original method (r = 0.756, n = 576) (P < 0.05). Our new method yielded a better correlation in the repeated measurement values of rMBF and less variability among the regions in the myocardium than with the original theory of the (15)O-water technique. The simulation study demonstrated fewer effects of error in the PTF or Va on the MBF value with the new method. CONCLUSION: We have developed a technique for an automated, simplified, and stable algorithm to quantify rMBF. This software is considered to be practical for clinical use in myocardial PET studies using (15)O-water with a high reproducibility and a short processing time.

Algorithms↗

PubMed2005

Accuracy of 4 different algorithms for the analysis of tomographic radionuclide ventriculography using a physical, dynamic 4-chamber cardiac phantom.

UNLABELLED: Various automatic algorithms are now being developed to calculate left ventricular (LV) and right ventricular (RV) ejection fraction from tomographic radionuclide ventriculography. We tested the performance of 4 of these algorithms in estimating LV and RV volume and ejection fraction using a dynamic 4-chamber cardiac phantom. METHODS: We developed a realistic physical, dynamic 4-chamber cardiac phantom and acquired 25 tomographic radionuclide ventriculography images within a wide range of end-diastolic volumes, end-systolic volumes, and stroke volumes. We assessed the ability of 4 algorithms (QBS, QUBE, 4D-MSPECT, and BP-SPECT) to calculate LV and RV volume and ejection fraction. RESULTS: For the left ventricle, the correlations between reference and estimated volumes (0.93, 0.93, 0.96, and 0.93 for QBS, QUBE, 4D-MSPECT, and BP-SPECT, respectively; all with P < 0.001) and ejection fractions (0.90, 0.93, 0.88, and 0.92, respectively; all with P < 0.001) were good, although all algorithms underestimated the volumes (mean difference [+/-2 SDs] from Bland-Altman analysis: -39.83 +/- 43.12 mL, -33.39 +/- 38.12 mL, -33.29 +/- 40.70 mL, and -16.61 +/- 39.64 mL, respectively). The underestimation by QBS, QUBE, and 4D-MSPECT was greater for higher volumes. QBS, QUBE, and BP-SPECT could also be tested for the right ventricle. Correlations were good for the volumes (0.93, 0.95, and 0.97 for QBS, QUBE, and BP-SPECT, respectively; all with P < 0.001). In terms of absolute volume estimation, the mean differences (+/-2 SDs) from Bland-Altman analysis were -41.28 +/- 43.66 mL, 11.13 +/- 49.26 mL, and -13.11 +/- 28.20 mL, respectively. Calculation of RV ejection fraction correlated well with true values (0.84, 0.92, and 0.94, respectively; all with P < 0.001), although an overestimation was seen for higher ejection fractions. CONCLUSION: Calculation of LV and RV ejection fraction based on tomographic radionuclide ventriculography was accurate for all tested algorithms. All algorithms underestimated LV volume; estimation of RV volume seemed more difficult, with different results for each algorithm. The more irregular shape and inclusion of a relatively hypokinetic RV outflow tract in the right ventricle seemed to cause the greater difficulty with delineation of the right ventricle, compared with the left ventricle.

Algorithms↗

PubMed2005

[Should a minor, unattended by a parent, be given medical services? Use of an algorithm to critique the Israel Ministry of Health regulations].

BACKGROUND: Parents are the natural custodians of their children, thus minors need parental approval to receive medical services. In February 2004, the Israel Ministry of Health issued a set of regulations titled "Visits of unaccompanied minors to primary care clinics", aimed at assisting primary care clinicians in their decision-making process on this sensitive issue. AIMS: (1) To convert the above mentioned regulations into an algorithmic format in order to facilitate their use by community clinicians, and (2) To review and critique the regulations, using the process of algorithm conversion. METHODS: The regulations were studied thoroughly. Three rounds of Delphi process for reaching consensus were used to create an algorithm, based on these regulations. The algorithm building process was used to critique the regulations. RESULTS: The Israel Ministry of Health regulations, "Visits of unaccompanied minors to primary care clinics", were found to be long and complicated. The process of building the algorithm revealed several difficulties certain concepts were not well defined, many exceptional situations were found and a large portion of the regulations was dedicated to reporting and record keeping. Converting the regulations into an algorithmic format simplified them and assisted in their CONCLUSIONS: Converting complex regulations into an algorithmic format can facilitate their daily use by community clinicians. Parts of the regulations for "Visits of unaccompanied minors to primary care clinics" are incompatible with present clinic routine and, therefore, difficult to implement.

Adolescent↗

PubMed2005

A space-efficient algorithm for the constrained pairwise sequence alignment problem.

The constrained pairwise sequence alignment (CPSA) problem aims to align two given sequences by aligning their similar subsequences in the same region under the guidance of a given pattern (constraint). Let the lengths of the sequences be m, and n where n <or= m, and let r <or= n be the length of the given pattern. The optimum constrained pairwise alignment score can be computed using O(rn) space by a naive dynamic programming solution. If an optimal alignment path is desired then the space requirement of the naive dynamic programming algorithm is O(rnm). There is a divide-and-conquer algorithm that reduces the memory requirement of finding an optimal alignment for the CPSA problem to O(rn). In this paper, we present a space-efficient CPSA algorithm that returns an optimal alignment. Our analysis on real protein sequences suggests that our algorithm requires only O(n) space in practice. This algorithm is not only space efficient but also very fast. A generalization of the CPSA problem for multiple sequences is called the constrained multiple sequence alignment (CMSA) problem. Our CPSA algorithm also improves the space requirement of progressive CMSA algorithms that use solutions of CPSA problems.

Algorithms↗

PubMed1991

Evaluation of a comprehensive algorithm for blunt and penetrating thoracic and abdominal trauma.

The objective was to develop a single branched-chain decision tree for both blunt and penetrating thoracic and abdominal trauma and to test its feasibility to track clinical decisions. The algorithm consisted of 14 specific patient management loops and 31 decision nodes. During a 4-month period, the management decisions and clinical course of 434 trauma patients were prospectively observed. Thirty-four patients had no signs of life on arrival to the emergency department (ED) and were excluded from the statistical evaluation; the remaining 400 patients constituted the study group. The mean Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and Trauma Score (TS) scores in the series were 21 +/- 10, 34 +/- 12, and 13 +/- 3. The overall patient mortality of the study group was 17 per cent; it was 61 per cent in those patients with major deviations from the algorithm and 6 per cent in patients who complied with the algorithm. The ISS, PATI, and TS scores were 29 +/- 9, 32 +/- 12, and 13 +/- 2 in patients with deviations and 20 +/- 10, 37 +/- 12, and 14 +/- 2 in patients who complied with the algorithm. Of the 37 patients who died with major deviations from the algorithm, the deviation was directly contributory to death in 21 cases (57%) and probably contributory in another 14 cases (38%). There were 108 patients with ISS scores between 20 and 50. In this group, mortality was 55 per cent when a major deviation occurred and 5 per cent without major deviations from the algorithm. The authors conclude that the survival of trauma patients may be improved by following the specific management criteria outlined by the algorithm.

Abdominal Injuries↗

PubMed1989

A selective mapping algorithm for computer analysis of voided urine cell images.

One of the fundamental targets of the automated image analysis of cytologic preparations is the reduction of computer classification errors due to cells or other objects that do not lend themselves to image segmentation or that have morphologic features that may mislead the cell classification schemes. In prior work from this laboratory, the achievement of this goal was attempted by hierarchical analysis of sequential microscopic objects at high resolution. This paper reports on the successful development and implementation of an automated "selective mapping algorithm" that selects cells at low power for further analysis and eliminates a large proportion of unwanted "objects." The algorithm classifies the objects and extracts appropriate features from a 256 X 240 digital image obtained via a 10 X planachromatic objective. The five-node binary tree classifier used in this triage is described. The algorithm was trained and tested initially on 501 visually classified microscopic "objects," resulting in a correct acceptance rate of 61.3% and correct rejection rate of 81.3%. The selective mapping algorithm was subsequently integrated into the video-based image analysis system constructed at the Montefiore Medical Center for the diagnostic evaluation of sediments of voided urine. The algorithm was then tested on ten cytocentrifuge preparations for a preliminary evaluation of its performance. Up to 100 "objects" per case were selected by the algorithm for further classification by the computer at high power. Of the 810 "objects" selected by the selective mapping algorithm, 344 (42.5%) were classified by the computer at high resolution as cells of diagnostic value ("WELL" cells) and 466 were rejected.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

PubMed1996

Algorithms for verbal autopsies: a validation study in Kenyan children.

The verbal autopsy (VA) questionnaire is a widely used method for collecting information on cause-specific mortality where the medical certification of deaths in childhood is incomplete. This paper discusses review by physicians and expert algorithms as approaches to ascribing cause of deaths from the VA questionnaire and proposes an alternative, data-derived approach. In this validation study, the relatives of 295 children who had died in hospital were interviewed using a VA questionnaire. The children were assigned causes of death using data-derived algorithms obtained under logistic regression and using expert algorithms. For most causes of death, the data-derived algorithms and expert algorithms yielded similar levels of diagnostic accuracy. However, a data-derived algorithm for malaria gave a sensitivity of 71% (95% Cl: 58-84%), which was significantly higher than the sensitivity of 47% obtained under an expert algorithm. The need for exploring this and other ways in which the VA technique can be improved are discussed. The implications of less-than-perfect sensitivity and specificity are explored using numerical examples. Misclassification bias should be taken into consideration when planning and evaluating epidemiological studies.

Algorithms↗

PubMed1996

[Comparative study of 3 algorithms to localize the accessory pathway in Wolff-Parkinson-White syndrome].

BACKGROUND AND OBJECTIVES: Some electrocardiographic algorithms have been developed to predict the location of the accessory pathway in the WPW syndrome. Few studies address the interobserver variability of such algorithms and the possible observer-dependent changes of accuracy. This study analyzes three algorithms to localize accessory pathways recently published, comparing the inter-observer variability, their predictive value and the most frequent problems observed during their application. METHODS: Ninety-six electrocardiograms from patients who underwent successful ablation of a single accessory pathway were reviewed. The location of each pathway was predicted by two independent observers according to three different reported electrocardiographic algorithms. The interobserver agreement, percentage of correct predictions and critical steps of each algorithm were analyzed. RESULTS: The interobserver agreement varied between 64 and 79% and the accuracy between 38 and 67%. The best results were obtained in the left lateral accessory pathways (69 to 89% correctly located). All the algorithms presented critical steps at which more than 20% of pathways were incorrectly classified. CONCLUSIONS: The analyzed algorithms present a high interobserver variability. The accuracy obtained is clearly lower than that reported by the corresponding authors. These facts should be considered when being used them in clinical settings.

Adult↗

PubMed1996

Management of four arterial blood gas problems in adult mechanical ventilation: decision-making algorithms and rationale for their use.

Use of these algorithms does not eliminate the need to think. One must always evaluate each patient to determine if the algorithms are applicable. The algorithms provide a learning framework for any practitioner who is responsible for managing patients receiving mechanical ventilation. The effectiveness of any reference tool depends, to an extent, on the context in which it is applied. The use of these algorithms without an adequate understanding of the principles of gas exchange, acid-base balance, and the function of mechanical ventilators will probably not benefit the patient or the practitioner. The portable nature of these algorithms allows them to be used in the clinical setting. The ultimate goal, of course, is to replace the algorithms with the ability to make and justify mechanical ventilation decisions. Experience with these algorithms will also assist users in applying this approach with unfamiliar problems to find viable solutions.

Adult↗

PubMed1997

An evaluation of the application of the genetic algorithm to the problem of ordering genetic loci on human chromosomes using radiation hybrid data.

We consider the problem of ordering detectable genetic loci along a chromosome by minimizing the number of obligatory breaks that can be inferred from radiation hybrid data. The problem bears some resemblance to the travelling-salesman problem, for which genetic algorithms have been used with considerable success. We find that the results from other studies on closely related problems are not directly transferable, and although we did find a genetic algorithm that performed well in this application it would appear that this algorithm is highly sensitive to any changes in the problem. Moreover, a very simple stochastic algorithm performed almost as well as our much more complicated and computer-intensive genetic algorithm and it did so in a fraction of the time. While we do not dispute that genetic algorithms can work on large complicated problems, the various modifications and fine-tuning necessary for good performance tend to be highly problem specific and they are often only arrived at after an exhaustive exploration of possibilities. Thus, we would dispute any claim that genetic algorithms are robust in their form and range of applicability.

Algorithms↗

PubMed1998

Screening for sexually transmitted diseases in rural women in Papua New Guinea: are WHO therapeutic algorithms appropriate for case detection?

The presence of a large reservoir of untreated sexually transmitted diseases (STDs) in developing countries has prompted a number of suggestions for improving case detection, including the use of clinical algorithms and risk assessments to identify women likely to be infected when they present to clinics for other reasons. We used data from a community-based study of STDs to develop and evaluate algorithms for detection of cervical infection with Chlamydia trachomatis or Neisseria gonorrhoeae, and for detection of vaginal infection with Trichomonas vaginalis or bacterial vaginosis. The algorithms were derived using data from 192 randomly selected women, then evaluated on 200 self-selected women. We evaluated the WHO algorithm for vaginal discharge in both groups. The prevalences of cervical and vaginal infection in the randomly selected group were 27% and 50%, respectively, and 23% and 52%, respectively, in the self-selected group. The derived algorithms had high sensitivities in both groups, but poor specificities in the self-selected women, and the positive predictive values were unacceptably low. The WHO algorithms had extremely low sensitivity for detecting either vaginal or cervical infection because relatively few women reported vaginal discharge. Simple algorithms and risk assessments are not valid for case detection in this population.

Adolescent↗

PubMed2006

Improving metabolic control in sub-optimally controlled subjects with Type 1 diabetes: comparison of two treatment algorithms using insulin glargine.

This study assessed the incidence of severe hypoglycaemia with two insulin glargine titration algorithms: Algorithm 1 (increments of at least 10%, but not exceeding 4U) versus Algorithm 2 (1-6U increments). In this multicenter (n=409), multinational (n=54), open-label, 24-week randomized trial in 2442 subjects with sub-optimally controlled Type 1 diabetes (T1DM), mean prior insulin therapy duration was 14.6+/-10.3 years. The incidence of severe hypoglycaemia was similar with Algorithms 1 and 2 (16.6events/100 patient-years versus 14.4events/100 patient-years). There were similar rates of both symptomatic and nocturnal hypoglycaemia. HbA(1c) and fasting blood glucose (FBG) decreased significantly (baseline to endpoint; p<0.001), and comparably with Algorithms 1 and 2 (HbA(1c): -0.64% versus -0.72%; FBG: -57mg/dL versus -59mg/dL). Mean basal insulin dose increased with both algorithms (+5.7U versus +5.9U). In a diverse population with longstanding T1DM, transfer from any insulin regimen, including basal-bolus or premixed insulin to an insulin glargine-based regimen resulted in significant improvements in glycaemic control, with low rates of severe hypoglycaemia, irrespective of the titration algorithm used.

Adult↗

PubMed1998

Deterministic annealing EM algorithm.

This paper presents a deterministic annealing EM (DAEM) algorithm for maximum likelihood estimation problems to overcome a local maxima problem associated with the conventional EM algorithm. In our approach, a new posterior parameterized by `temperature' is derived by using the principle of maximum entropy and is used for controlling the annealing process. In the DAEM algorithm, the EM process is reformulated as the problem of minimizing the thermodynamic free energy by using a statistical mechanics analogy. Since this minimization is deterministically performed at each temperature, the total search is executed far more efficiently than in the simulated annealing. Moreover, the derived DAEM algorithm, unlike the conventional EM algorithm, can obtain better estimates free of the initial parameter values. We also apply the DAEM algorithm to the training of probabilistic neural networks using mixture models to estimate the probability density and demonstrate the performance of the DAEM algorithm.

Journal Article↗

PubMed1998

A unified algorithm for principal and minor components extraction.

Principal component and minor component extractions provide powerful techniques in many information-processing fields. However, by conventional algorithms minor component extraction is much more difficult than principal component extraction. A unified algorithm which can be used to extract both principal and minor component eigenvectors is proposed. This 'unified' algorithm can extract true principle components (eigenvectors) and if altered simply by the sign, it can also serve as a true minor components extractor. This is of practical significance in neural network implementation. It is shown how the present algorithms are related to Oja's principal subspace algorithm, Xu's algorithm and the Brockett flow. It is also shown that the algorithms are based on the natural gradient ascend/descent methods (a potential flow in a Riemannian space).

Journal Article↗

PubMed2005

A new algorithm for predicting triplet-triplet energy-transfer activated complex coordinate in terms of accurate potential-energy surfaces.

The new algorithm presented here allows, for the first time, the determination of the optimal geometrical distortions that an acceptor molecule in the triplet-triplet energy-transfer process undergoes, as well as the dependence of the activation energy of the process on the triplet energy difference of donor and acceptor molecules. This algorithm makes use of the complete potential-energy surfaces (singlet and triplet states), and contrasts with the first-order approximation already published [L. M. Frutos, O. Castano, J. L. Andres, M. Merchan, and A. U. Acuna, J. Chem. Phys. 120, 1208 (2004)] in which an expansion of the potential-energy surfaces was used. This algorithm is gradient based and finds the best trajectory for the acceptor molecule, starting from S(0) ground-state equilibrium geometry, to achieve the maximum variation of the singlet-triplet energy gap with the minimum energy of activation on S(0). Therefore, the algorithm allows the determination of a "reaction path" for the triplet-triplet energy-transfer processes. Also, the algorithm could also serve eventually to find minimum-energy crossing (singlet-triplet) points on the potential-energy surface, which can play an important role in the intersystem crossing process for the acceptor molecules to recover their initial capacity as acceptors. Also addressed is the misleading use of minimum-energy paths in T(1) to describe the energy-transfer process by comparing these results with those obtained using the new algorithm. The implementation of the algorithm is illustrated with different potential-energy surface models and it is discussed in the frame of nonvertical behavior.

Journal Article↗

PubMed1983

Clinical aspects of resuscitation with and without an algorithm: relative importance of various decisions.

Clinical description was made of a series of hypotensive patients resuscitated with and without an algorithm. Of 603 hypotensive patients, there were 114 (19%) deaths and 169 (28%) patients with complications; the average low MAP was 53 +/- 25 mm Hg. Of 169 patients with complications, 48 (28%) had shock-related (SR) complications; 25 (52%) of these patients died. There were 265 (44%) patients who had severe associated diseases and these patients comprised the group most vulnerable to complications and death; in this group, there were 41 patients with SR-complications who had significantly higher mortality, longer resuscitation times, lower MAP, more deviations from the algorithm, and more delays in resuscitation than did those with nonshock-related complications. Multiple deviations from the algorithm were associated with longer resuscitation times, and higher incidence of SR complications. Most of the delays in resuscitation of these patients and most of the SR complications could have been prevented. Seventeen percent of hypotensive patients entering the emergency department (ED) normally carried low arterial pressures, which averaged 75 +/- 3 (SD) mm Hg; this was more common, but not confined to young females. Of the 603 patients who actually were hypotensive, 6% were admitted in arrest (phase I), 18% in severe shock (phase II, MAP less than 60 mm Hg), 52% in moderate shock (phase III, MAP less than 80 mm Hg), and 24% were normotensive but subsequently became hypotensive (phase IV). The importance of various decision nodes of the algorithm were evaluated. The present algorithm, designed for these hypotensive emergency patients, provides a framework for fluid management that expedites resuscitation and reduces complications related to shock. We conclude that: (a) delays in resuscitation can be clearly related to an increased incidence of SR complications; (b) when the algorithm was satisfactorily followed, there was faster resuscitation and less SR complications; and (c) when the algorithm was satisfactorily followed in patients with severe associated illnesses, there was also shorter ICU stay, shorter hospitalization and decreased mortality.

Adolescent↗