Automated CCHD screening and detection
Automated critical congenital heart defect (“CCHD”) screening systems and processes are described. A caregiver may be guided to use a single or dual sensor pulse oximeter to obtain pre- and post-ductal blood oxygenation measurements. A delta of the measurements indicates the possible existence or nonexistence of a CCHD. Errors in the measurements are reduced by a configurable measurement confidence threshold based on, for example, a perfusion index. Measurement data may be stored and retrieved from a remote data processing center for repeated screenings.
1. A method of determining a likelihood of a critical congenital heart defect using a pulse oximeter, the method comprising:
displaying, on a display of a pulse oximeter, instructions to a caregiver to position a noninvasive sensor at a first measurement site on a patient predetermined to be substantially indicative of a pre-ductal blood oxygenation level and not substantially indicative of a post-ductal blood oxygenation level, wherein the noninvasive sensor is configured to output signals responsive to attenuation of light at measurement sites on the patient to the pulse oximeter, wherein the first measurement site is on a first limb of the patient;
receiving the output signals indicative of the pre-ductal blood oxygenation level at the first measurement site;
displaying, on the display of the pulse oximeter, an indication to the caregiver of a success or failure of obtaining a measure of pre-ductal blood oxygenation level at the first measurement site;
displaying, on the display of the pulse oximeter, instructions to the caregiver to position the noninvasive sensor at a second measurement site on the patient predetermined to be substantially indicative of a post-ductal blood oxygenation level and not substantially indicative of a pre-ductal blood oxygenation level, wherein the second measurement site is on a second limb of the patient, and wherein the second limb of the patient is different from the first limb of the patient;
receiving the output signals indicative of the post-ductal blood oxygenation level at the second measurement site;
displaying, on the display of the pulse oximeter, an indication to the caregiver of a success or failure of obtaining a measure of post-ductal blood oxygenation level at the second measurement site;
processing, by one or more hardware processors of the pulse oximeter, the pre-ductal blood oxygenation level and the post-ductal oxygenation level to determine a likelihood that the patient has a critical congenital heart defect, wherein said processing comprises at least time-wise aligning of at least portions of the output signals indicative of the pre-ductal blood oxygenation level and the output signals indicative of the post-ductal blood oxygenation level; and
displaying, on the display of the pulse oximeter, an indication to the caregiver of the likelihood that the patient has the critical congenital heart defect.
2. The method of claim 1 further comprising:
displaying, on the display of the pulse oximeter, instructions to the caregiver to proceed with an additional screening for the critical congenital heart defect after a period of time.
3. The method of claim 1 , wherein displaying the indication of the likelihood that the patient has the critical congenital heart defect comprises:
displaying, on the display of the pulse oximeter, an indication of a difference between the measure of pre-ductal blood oxygenation level and the measure of post-ductal blood oxygenation level.
4. The method of claim 3 , wherein displaying the indication of the likelihood that the patient has the critical congenital heart defect further comprises:
displaying, on the display of the pulse oximeter, an indication of the measure of pre-ductal blood oxygenation level and the measure of post-ductal blood oxygenation level.
5. The method of claim 4 , wherein displaying the indication of the likelihood that the patient has the critical congenital heart defect further comprises:
displaying, on the display of the pulse oximeter, respective measures of perfusion index associated with each of the measure of pre-ductal blood oxygenation level and the measure of post-ductal blood oxygenation level.
6. The method of claim 5 , wherein displaying the indication of the likelihood that the patient has the critical congenital heart defect further comprises:
displaying, on the display of the pulse oximeter, an indication of a confidence in the likelihood that the patient has the critical congenital heart defect.
7. The method of claim 1 further comprising:
displaying, on the display of the pulse oximeter, an indication of a progress of obtaining the measure of pre-ductal blood oxygenation level at the first measurement site.
8. The method of claim 1 further comprising:
displaying, on the display of the pulse oximeter, an indication of a progress of obtaining the measure of post-ductal blood oxygenation level at the second measurement site.
9. The method of claim 1 , wherein the first measurement site comprises a right hand of the patient.
10. The method of claim 9 , wherein the second measurement site comprises at least one of a foot or left hand of the patient.
11. The method of claim 1 , wherein:
the output signals indicative of the pre-ductal blood oxygenation level at the first measurement site are received during a first duration of time, and comprise a first waveform responsive to a pre-ductal oxygen saturation of the patient;
the output signals indicative of the post-ductal blood oxygenation level at the second measurement site are received during a second duration of time, and comprise a second waveform responsive to a post-ductal oxygen saturation of the patient; and
processing, by the one or more hardware processors of the pulse oximeter, the pre-ductal blood oxygenation level and the post-ductal oxygenation level to determine the likelihood that the patient has a critical congenital heart defect comprises:
electronically determining, by the one or more hardware processors, one or more waveform features in the first waveform responsive to the pre-ductal oxygen saturation;
electronically determining, by the one or more hardware processors, one or more of the one or more waveform features in the second waveform responsive to the post-ductal oxygen saturation;
electronically time-wise aligning, by the one or more hardware processors, one or more of the one or more waveform features from the first waveform with one or more of the one or more waveform features from the second waveform;
electronically determining, by the one or more hardware processors, a pre-ductal value of the first waveform at a first time; and
electronically determining, by the one or more hardware processors, a post-ductal value of the second waveform at the first time taking into account the time-wise aligning,
wherein displaying the indication of the likelihood that the patient has the critical congenital heart defect comprises: in response to determining the pre-ductal value and the post-ductal value differ by a predetermined threshold, outputting display indicia to the display indicating a likelihood that the patient has the critical congenital heart defect.
12. The method of claim 11 , wherein said first time comprises a third duration of time, and wherein determining said pre-ductal value and said post-ductal value differ by the predetermined threshold comprises:
calculating an average difference between said pre-ductal value and said post-ductal value over the third duration of time.
13. The method of claim 12 , wherein said first duration of time and said second duration of time each comprise at least sixty seconds.
14. The method of claim 13 , wherein said third duration of time comprises at least thirty seconds.
15. The method of claim 11 , wherein said one or more waveform features from said first waveform comprise at least one of: a trough, a peak, a natural high cycle of oxygen saturation, a natural low cycle of oxygen saturation, or a cyclical variation.
16. The method of claim 11 , wherein processing, by the one or more hardware processors of the pulse oximeter, the pre-ductal blood oxygenation level and the post-ductal oxygenation level to determine the likelihood that the patient has a critical congenital heart defect further comprises:
discarding a waveform when a quality of said output signals is outside of a pre-determined range.
17. The method of claim 11 , wherein processing, by the one or more hardware processors of the pulse oximeter, the pre-ductal blood oxygenation level and the post-ductal oxygenation level to determine the likelihood that the patient has a critical congenital heart defect further comprises:
receiving said signal outputs to obtain a third waveform responsive to a blood perfusion level of the patient, wherein a waveform is discarded when the blood perfusion level associated with the waveform is outside of a pre-determined range.
18. A pulse oximetry based system configured to determine a likelihood of a critical congenital heart defect, the system comprising:
a noninvasive sensor configured to output signals responsive to an attenuation of light at measurement sites on a patient; and
a pulse oximeter in communication with the noninvasive sensor to drive light sources of said noninvasive sensor and to receive said output signals, said pulse oximeter including one or more hardware processors configured to:
display, on a display of the pulse oximeter, instructions to a caregiver to position the noninvasive sensor at a first measurement site on a patient predetermined to be substantially indicative of a pre-ductal blood oxygenation level and not substantially indicative of a post-ductal blood oxygenation level;
receive the output signals indicative of the pre-ductal blood oxygenation level at the first measurement site;
display, on the display of the pulse oximeter, an indication to the caregiver of a success or failure of obtaining a measure of pre-ductal blood oxygenation level at the first measurement site;
display, on the display of the pulse oximeter, instructions to the caregiver to position the noninvasive sensor at a second measurement site on the patient predetermined to be substantially indicative of a post-ductal blood oxygenation level and not substantially indicative of a pre-ductal blood oxygenation level, wherein the second measurement site is on a second limb of the patient, and wherein the second limb of the patient is different from the first limb of the patient;
receive the output signals indicative of the post-ductal blood oxygenation level at the second measurement site;
display, on the display of the pulse oximeter, an indication to the caregiver of a success or failure of obtaining a measure of post-ductal blood oxygenation level at the second measurement site;
process, by the one or more hardware processors of the pulse oximeter, the pre-ductal blood oxygenation level and the post-ductal oxygenation level to determine a likelihood that the patient has a critical congenital heart defect wherein said processing comprises at least time-wise aligning of at least portions of the output signals indicative of the pre-ductal blood oxygenation level and the output signals indicative of the post-ductal blood oxygenation level; and
display, on the display of the pulse oximeter, an indication to the caregiver of the likelihood that the patient has the critical congenital heart defect.
19. The system of claim 18 , wherein:
the output signals indicative of the pre-ductal blood oxygenation level at the first measurement site are received during a first duration of time, and comprise a first waveform responsive to a pre-ductal oxygen saturation of the patient;
the output signals indicative of the post-ductal blood oxygenation level at the second measurement site are received during a second duration of time, and comprise a second waveform responsive to a post-ductal oxygen saturation of the patient; and
processing, by the one or more hardware processors of the pulse oximeter, the pre-ductal blood oxygenation level and the post-ductal oxygenation level to determine the likelihood that the patient has a critical congenital heart defect comprises:
electronically determining, by the one or more hardware processors, one or more waveform features in the first waveform responsive to the pre-ductal oxygen saturation;
electronically determining, by the one or more hardware processors, one or more of the one or more waveform features in the second waveform responsive to the post-ductal oxygen saturation;
electronically time-wise aligning, by the one or more hardware processors, one or more of the one or more waveform features from the first waveform with one or more of the one or more waveform features from the second waveform;
electronically determining, by the one or more hardware processors, a pre-ductal value of the first waveform at a first time; and
electronically determining, by the one or more hardware processors, a post-ductal value of the second waveform at the first time taking into account the time-wise aligning,
wherein displaying the indication of the likelihood that the patient has the critical congenital heart defect comprises: in response to determining the pre-ductal value and the post-ductal value differ by a predetermined threshold, outputting display indicia to the display indicating a likelihood that the patient has the critical congenital heart defect.