A custom made interface to integrate recording of pulse rate and blood pressure during urodynamics investigations.

Patients with a spinal cord injury above the 6th thoracic vertebrae may be prone to autonomic dysreflexia (AD) in response to bladder stimulus associated with a urodynamics investigation. It is essential that these patients are managed carefully in the urodynamics clinic in order to prevent life-threatening hypertension and bradycardia. Part of this management is the measurement and manual recording of pulse rate (PR) and non-invasive blood pressure (NIBP), alongside the standard urodynamics data set. The purpose of recording these additional data is to identify the characteristic drop in PR and rise in NIBP that indicates the onset of AD. This technical note describes the development of a novel, in-house constructed interface that allows PR and NIBP to be recorded alongside the standard urodynamics data set, using a commonly available vital signs monitor and urodynamics workstation.

Real-time symptom reporting during elective intracranial pressure monitoring using an interactive handset.

BACKGROUND: Determining whether symptoms are related to abnormal intracranial pressure (ICP) may prove challenging in some cases. We evaluated the utility of an in-house designed interactive handset which allows the real-time recording of symptoms during ICP monitoring. METHODS: Adult patients undergoing elective continuous ICP monitoring using the device to investigate symptoms between November 2013 and June 2015 were included in this retrospective observational cohort study. The device allowed the following symptoms to be recorded: mild, moderate and severe headache, visual disturbance and nausea. The corresponding ICP and ICP trend were also recorded. RESULTS: Twenty seven patients underwent 29 episodes of ICP monitoring, reporting 383 symptoms (mild 18%, moderate 39%, severe 20% headaches, visual disturbance 15% and nausea 8%) over a median period of 48 hours (IQR 12). The median number of symptoms reported during each episode was 11 (IQR 11). The mean ICP associated with a symptom episode was 7mmHg (Range -10 to 45). Mild, moderate and severe headache complaints were associated with mean ICPs of 5 (-9 to 26), 6 (-10 to 35) and 14 (-10 to 45) mmHg respectively. The majority of complaints (68%) were reported during instances of normal ICP. Following monitoring, non-operative management was employed on 21 occasions (72%) including valve pressure adjustment on two occasions whilst surgical intervention was required on eight occasions (28%; two surgeries for under-drainage and six for over-drainage). CONCLUSIONS: The device allows the clinician to accurately match a patient's symptoms with ICP to facilitate management decisions. In most instances, symptoms did not closely correlate with an abnormal ICP. By automating and standardising the collection of symptom data, this device may serve as an efficient adjunct when investigating patients with complex hydrocephalus.