The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients

Abstract

BACKGROUND:Eye tracking (ET) may be a novel tool to enable nonverbal communication. We hypothesized that ET could be used successfully by intensive care unit (ICU) patients with artificial airways to express their levels of pain and mood, quality of life, and self-esteem with predefined scales and scores. METHODS:Prospective, monocentric, observational study, including patients with an endotracheal tube or tracheostomy tube and a history of mechanical ventilation for more than 48 hours without delirium, and inadequate nonverbal communication skills. The ICU patients' pain was assessed with a numeric rating scale, their mood was tested with a smiley analog scale. Quality of life and self-esteem were measured with the European quality of life-5 dimensions-5 levels-score and the visual analog self-esteem scale. RESULTS:A total of 75 patients with a mean age of 58.3 years were included. Main diagnoses for ICU admission were major trauma (45.3%), nonabdominal sepsis (22.6%), and acute abdomen (13.3%). Patients showed moderate levels of pain and sadness with a median of 4 (interquartile range, 3-5.5) on the numeric rating scale and a median of 4 (interquartile range, 3-4) on the smiley analog scale.The general health status on the European quality of life-5 dimensions-5 levels-score was rated as poor. Reporting on the visual analog self-esteem scale, most of the included patients felt trapped (90.7%) and not confident (72%), were frustrated (64%) or did not feel understood (56%). However, despite their severe illness, many patients classified themselves as intelligent (30.6%), not mixed up (38.6%), outgoing (38.6%), and optimistic (44%). CONCLUSION:Eye tracking enables symptom identification in critically ill voiceless patients with impaired communication options. The results of our study may provide guidance for improvement measures in the care of voiceless ICU patients. We believe that ET is useful for symptom identification and therefore may be capable of improving patient-medical team interaction and patient satisfaction. (J

Three patterns of symptom communication between patients and clinicians in the intensive care unit: A fieldwork study

“…The prototype of symptom assessment in patients able to self-report is pain assessment, and the most basic form of general symptom assessment in patients with communication difficulties is asking yes/no questions (Chanques et al, 2015). Existing assessment tools have limited usability for patients with communication impairments (Ull et al, 2022), but Choi et al (2017) offer a description of how to facilitate symptom assessment in non-vocal ICU patients, emphasizing the need to adapt the assessment to the communication abilities of the patient, and minimizing the burden of the assessment for the patient. When patients are unable to self-report, symptoms are assessed by observing behaviour, observations by proxies, or by assuming the presence of symptoms under certain circumstances (Choi et al, 2017;Devlin et al, 2018;Puntillo et al, 2014).…”

Letter to the editor: Failing an automated comprehension test while being able to report on needs: eyetracking in critically ill intubated patients should not be underestimated

“…This is one reason: We believe that the results from Bodet-Contentin substantially underestimate the ability of their patients to thoughtfully communicate by using the eye-tracking technology. Another reason lies in the observation that intubated critically ill patients can consistently report on their appraisals of their situation via eye fixations on response panels [ 6 ]. For instance, 90% indicate to feel trapped (while other items show lower approval rates).…”

“…Accounting for the high level of concentration required by the patients their motivation to give answers might be reduced. Beyond the example just mentioned, in several studies it has been shown that critically ill patients are quite able to give differentiated answers questions concerning their actual situation, requirements, and projections on their future [ 3 – 6 ]. Thirdly, although automation of tasks will allow the medical personal on an ICU to focus on other duties, in this particular setting, we feel that a personal interaction with a human being would be preferable.…”

“…Another reason lies in the observation that intubated critically ill patients can consistently report on their appraisals of their situation via eye fixations on response panels [ 6 ]. For instance, 90% indicate to feel trapped (while other items show lower approval rates).…”

“…Accounting for the high level of concentration required by the patients their motivation to give answers might be reduced. Beyond the example just mentioned, in several studies it has been shown that critically ill patients are quite able to give differentiated answers questions concerning their actual situation, requirements, and projections on their future [ 3 – 6 ].…”