Wireless monitoring and real-time adaptive predictive indicator of deterioration

Abstract

to assist in the early warning of deterioration in hospitalised children we studied the feasibility of collecting continuous wireless physiological data using Lifetouch (ecG-derived heart and respiratory rate) and WristOx2 (pulse-oximetry and derived pulse rate) sensors. We compared our bedside paediatric early warning (peW) score and a machine learning automated approach: a Real-time Adaptive Predictive Indicator of Deterioration (RAPID) to identify children experiencing significant clinical deterioration. 982 patients contributed 7,073,486 min during 1,263 monitoring sessions. The proportion of intended monitoring time was 93% for Lifetouch and 55% for WristOx2. Valid clinical data was 63% of intended monitoring time for Lifetouch and 50% WristOx2. 29 patients experienced 36 clinically significant deteriorations. The RAPID Index detected significant deterioration more frequently (77% to 97%) and earlier than the PEW score ≥ 9/26. High sensitivity and negative predictive value for the RAPID Index was associated with low specificity and low positive predictive value. We conclude that it is feasible to collect clinically valid physiological data wirelessly for 50% of intended monitoring time. The RAPID Index identified more deterioration, before the PEW score, but has a low specificity. By using the RAPID Index with a PEW system some life-threatening events may be averted. Paediatric Early Warning (PEW) systems have reduced the late or undetected clinical deterioration experienced by some hospitalised children 1-3. Following the introduction of the bedside PEW score in Birmingham Children's Hospital, a multidisciplinary team identified missed opportunities and recommended more continuous monitoring for visualisation of trends and a smart alarm for earlier detection of deterioration. Continuous and intermittent monitoring has led to early identification of patient deterioration, increased rapid response activations and improvements in completeness of vital signs documentation 4,5. Standard monitors require sensors to be hard-wired to patients and require additional software to extract data for advanced analytics 6. Wireless monitoring offers a potentially more comfortable and economical solution although accuracy, continuity, patient tolerability and power management are challenging 7,8. A number of sensors and monitoring systems have been developed and shown to be feasible but few have been sufficiently developed and tested in large clinical trials 7-15. The advantage of more continuous monitoring for ward patients is that trends and Big Data analytics can be used to improve detection of deterioration 16-18. The intent is not that smart alarms replace clinical surveillance but that they are used in addition to current systems to support and augment decision making 19-21. Neither continuous wireless monitoring nor integrated smart alarms have been reported in the context of paediatric wards. This study tests the feasibility of collecting sufficiently useful continuous wireless monitoring and the feasibility of a re...

Vital sign monitoring using wearable devices in a Vietnamese intensive care unit

“…Our study agrees with previous studies using wearable devices in that significant amounts of signal loss occurred. 7 Reasons for this may be both physical (eg, poor quality or faulty devices) and contextual. Our rationale in performing this study in patients with tetanus was that they present many issues for wearable devices.…”

“…4 Some of these devices have the additional advantage of being able to record continuous data, which allow more complex analysis and may facilitate even better risk prediction. [5][6][7] There is, however, limited use of these devices in the unique and challenging environments of LMIC intensive care units (ICUs). 3 The majority of validatory data concerning wearables come from community settings in relatively healthy ambulatory individuals.…”

“…10 13 The suitability of low-cost wearables to record continuous waveform data in critically ill patients is even less certain, as these systems may be limited by high levels of noise, movement artefact and missing data. 7 Early-stage innovation report…”

What Is the Impact of Ambulatory Vital Sign Monitoring on Deterioration Detection and Related Clinical Outcomes in Hospitalised Patients: a Systematic Review and Meta-analysis.

“…1). Four studies appeared to meet the inclusion criteria but were excluded at full-text review: two studies were excluded for not reporting a subset of their analysis for the patients using the AMS [32,33]; one was excluded after con rming with the author that the device was not ambulatory at the time of the study [34], and another did not have a comparator group [35]. A total of 4433 patients were included in these studies.…”

“…In addition, a recent study in the paediatric population concluded that wireless monitoring is feasible and can identify more deteriorations. The authors suggest that by using this in combination with a paediatrics early warning (PEW), some life-threatening events may be prevented [35].…”