Assessment of Apple Watch Series 6 pulse oximetry and electrocardiograms in a pediatric population

Abstract

Background Recent technologic advances have resulted in increased development and utilization of direct-to-consumer cardiac wearable devices with various functionality. This study aimed to assess Apple Watch Series 6 (AW6) pulse oximetry and electrocardiography (ECG) in a cohort of pediatric patients. Methods This single-center, prospective study enrolled pediatric patients ≥ 3kg and having an ECG and/or pulse oximetry (SpO2) as part of their planned evaluation. Exclusion criteria: 1) non-English speaking patients and 2) patients in state custody. Simultaneous tracings were obtained for SpO2 and ECG with concurrent standard pulse oximeter and 12-lead ECG. AW6 automated rhythm interpretations were compared to physician over-read and categorized as accurate, accurate with missed findings, inconclusive (automated interpretation: “inconclusive”), or inaccurate. Results A total of 84 patients were enrolled over a 5-week period. 68 patients (81%) were placed into the SpO2 and ECG arm, with 16 patients (19%) placed into the SpO2 only arm. Pulse oximetry data was successfully collected in 71/84 (85%) patients and ECG data in 61/68 (90%). ΔSpO2 between modalities was 2.0±2.6% (r = 0.76). ΔRR was 43±44msec (r = 0.96), ΔPR 19±23msec (r = 0.79), ΔQRS 12±13msec (r = 0.78), and ΔQT 20±19msec (r = 0.9). The AW6 automated rhythm analysis yielded a 75% specificity and found: 1) 40/61 (65.6%) “accurate”, 2) 6/61 (9.8%) “accurate with missed findings”, 3) 14/61 (23%) “inconclusive”, and 4) 1/61 (1.6%) incorrect. Conclusion The AW6 can accurately measure oxygen saturation when compared to hospital pulse oximeters in pediatric patients and provide good quality single lead ECGs that allow for accurate measurement of RR, PR, QRS, and QT intervals with manual interpretation. The AW6-automated rhythm interpretation algorithm has limitations for smaller pediatric patients and patients with abnormal ECGs.

Accuracy of the Apple Watch Oxygen Saturation Measurement in Adults: A Systematic Review

“…The remaining five articles were included [2,[14][15][16][17]. A summary of extracted characteristics is available in Table 2.…”

“…Littell et al evaluated the performance of an Apple Watch series 6 in 84 patients with an age of <23 years but weight >3 kg who had an ECG ordered as part of their routine clinical care at a pediatric cardiology unit [16].…”

“…All publications declared that no conflict of interest was present. Two publications declared that no funding for the project had been received [ 2 , 16 ], and one publication declared a grant from the university as a funding source [ 17 ], while the remaining two publications did not mention funding [ 14 , 15 ].…”

“…Littell and colleagues were the only author group that uploaded data to a public repository [ 16 ]. Two of the remaining publications mentioned the data being available from the corresponding author upon reasonable request [ 2 , 17 ], while the others did not mention data availability [ 14 , 15 ].…”

“…Littell et al evaluated the performance of an Apple Watch series 6 in 84 patients with an age of <23 years but weight >3 kg who had an ECG ordered as part of their routine clinical care at a pediatric cardiology unit [ 16 ]. For the spO 2 measurement, patients were instructed to remain still for 15 seconds while the watch was placed on their wrists.…”