Novel wearable and contactless heart rate, respiratory rate, and oxygen saturation monitoring devices: a systematic review and meta‐analysis

Abstract

We performed a systematic review and meta-analysis to identify, classify and evaluate the body of evidence on novel wearable and contactless devices that measure heart rate, respiratory rate and oxygen saturations in the clinical setting. We included any studies of hospital inpatients, including sleep study clinics. Eighty-four studies were included in the final review. There were 56 studies of wearable devices and 29 of contactless devices. One study assessed both types of device. A high risk of patient selection and rater bias was present in proportionally more studies assessing contactless devices compared with studies assessing wearable devices (p = 0.023 and p < 0.0001, respectively). There was high but equivalent likelihood of blinding bias between the two types of studies (p = 0.076). Wearable device studies were commercially available devices validated in acute clinical settings by clinical staff and had more real-time data analysis (p = 0.04). Contactless devices were more experimental, and data were analysed post-hoc. Pooled estimates of mean (95%CI) heart rate and respiratory rate bias in wearable devices were 1.25 (À0.31-2.82) beats.min -1 (pooled 95% limits of agreement À9.36-10.08) and 0.68 (0.05-1.32) breaths.min -1 (pooled 95% limits of agreement À5.65-6.85). The pooled estimate for mean (95%CI) heart rate and respiratory rate bias in contactless devices was 2.18 (3.31-7.66) beats.min -1 (pooled limits of agreement À6.71-10.88) and 0.30 (À0.26-0.87) breaths.min -1 (pooled 95% limits of agreement À3. 94-4.29). Only two studies of wearable devices measured S p O 2 ; these reported mean measurement biases of 3.54% (limits of agreement À5.65-11.45%) and 2.9% (À7.4-1.7%). Heterogeneity was observed across studies, but absent when devices were grouped by measurement modality and reference standard. We conclude that, while studies of wearable devices were of slightly better quality than contactless devices, in general all studies of novel devices were of low quality, with small (< 100) patient datasets, typically not blinded and often using inappropriate statistical techniques. Both types of devices were statistically equivalent in accuracy and precision, but wearable devices demonstrated less measurement bias and more precision at extreme vital signs. The statistical variability in precision and accuracy between studies is partially explained by differences in reference standards.

Accuracy and Systematic Biases of Heart Rate Measurements by Consumer-Grade Fitness Trackers in Postoperative Patients: Prospective Clinical Trial

“…Studies on the use of fitness trackers in a perioperative setting or among patients with multiple pre-existing diseases are rare [ 12 ] and, according to systematic reviews, also hampered by a high risk of bias [ 13 ] and suffer from low quality [ 14 ]. In particular, it has been shown that motion artifacts influence the mean absolute error (MAE) of the measurements by up to 30% [ 15 ].…”

Are brief febrile seizures benign? A systematic review and narrative synthesis

“…Alternatively, counseling with reassurance but education about very low frequency outcomes would allow parents to pursue low-cost monitoring strategies. [47][48][49][50] Among children ages 1-4 years, SUDC is more than 2 times as common as deaths due to house fires (~100 case/year), and about half as common as drownings (~475 deaths/year), yet public education for both fire prevention and water accidents is commonplace, whereas SUDC education is not. 8,47,51 Febrile seizures are not considered epilepsy but may be the first presentation of an epilepsy syndrome.…”

“…We should consider developing low-cost monitoring/alarming systems to reduce the frequency of these deaths, similar to efforts in SUDEP prevention. 48,49,50,52 Understanding genetic, biologic, and environmental factors that predispose a child's brain to febrile seizures may help distinguish adverse outcomes from pathogenesis. Genetic factors identified in genome-wide association studies related to fever response and neuronal excitability may represent biomarkers, as well as collaborative studies of SUDEP and SUDC.…”

Use of a smartwatch as a remote monitoring device during transport to, and inside, a computed tomography suite

“…A recent meta‐analysis by Chan et al. suggests that wearable devices may offer acceptable accuracy and precision in monitoring, though high quality studies are still needed [6].…”

“…McFarlane et al and Perez et al have supported using smartwatches in critical care settings and to detect asymptomatic episodes of atrial fibrillation [3,4], and utility in the early detection of COVID-19 has also been described [5]. A recent meta-analysis by Chan et al suggests that wearable devices may offer acceptable accuracy and precision in monitoring, though high quality studies are still needed [6].…”