Protocol for a systematic review assessing ambulatory vital sign monitoring impact on deterioration detection and related clinical outcomes in hospitalised patients

Abstract

IntroductionAmbulatory monitoring systems (AMS) can facilitate early detection of clinical deterioration, and have the potential to improve hospitalised patient outcomes. The objective of this systematic review is to assess the impact of vital signs monitoring on detection of deterioration and related outcomes in hospitalised patients using AMS, in comparison with standard care.Methods and analysisA systematic search was conducted on 27 August 2020 in MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL and Health Technology Assessment databases, as well as grey literature. Search results will be reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist for systematic reviews. Studies comparing the use of ambulatory monitoring devices against standard care for deterioration detection and related clinical outcomes in hospitalised patients will be included and further clinical and other outcomes will also be explored. Deterioration-related outcomes may include (but not limited to) unplanned intensive care admissions, rapid response team activation and unscheduled emergency interventions, as defined by the included studies. Two reviewers will independently extract study data and assess the quality and risk of bias of included studies. Where possible, a meta-analysis will be conducted and quantitative results presented. Alternatively, a narrative synthesis will be reported.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. This study is part of our virtual High Dependency Unit project and will be disseminated through peer-reviewed publications, public and scientific conference presentations.PROSPERO registration numberCRD42020188633.

The impact of wearable continuous vital sign monitoring on deterioration detection and clinical outcomes in hospitalised patients: a systematic review and meta-analysis

“…For randomised controlled trials the Cochrane risk of bias tool (RoB2) was used [ 23 ]; for non-randomised studies, the Newcastle Ottawa Scale (NOS) [ 24 ] and the “Risk Of Bias In Non-randomised Studies—of Interventions” (ROBINS-I) were applied [ 25 ]; and, in addition, the Mixed Methods Appraisal tool (MMAT) [ 26 ] was used for all studies. This was a change from the original protocol [ 19 ] as the Jadad scale was replaced by the ROBINS-I for assessment of non-randomised studies, as we found it more comparable with the ROB2 tool used for included RCTs. Two reviewers (CA and CB) independently appraised each study and disagreements were solved by discussion until consensus was reached with a third reviewer (SV).…”

“…This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist (Additional file 1 : Appendix 1) [ 18 ]. The full systematic review protocol was published prospectively [ 19 ].…”

“…Complete inclusion and exclusion criteria are available in the published protocol [ 19 ]. We included any studies conducted in hospitalised patients, excluding studies conducted in healthy volunteers or non-hospitalised patients.…”

“…every 5 min) and where measurements did not require frequent manual input from clinical staff. For comparator we considered any type of standard care for vital sign monitoring, as defined in the study protocol [ 19 ].…”

“…The included abstracts full-texts were assessed for eligibility and disagreements resolved by discussion between the 2 review authors; if no agreement could be reached, a third author was consulted (SV). The full selection process is outlined in the published protocol [ 19 ].…”