by
Madrigal-Garcia, Maria Isabel; Rodrigues, Marcos; Shenfield, Alex; Singer,
Mervyn; Moreno-Cuesta, Jeronimo
Objectives:
To identify facial expressions occurring in patients at risk of deterioration
in hospital wards. Design: Prospective observational feasibility study.
Setting: General ward patients in a London Community Hospital, United Kingdom.
Patients: Thirty-four patients at risk of clinical deterioration.
Interventions: A 5-minute video (25 frames/s; 7,500 images) was recorded,
encrypted, and subsequently analyzed for action units by a trained facial
action coding system psychologist blinded to outcome. Measurements and Main Results:
Action units of the upper face, head position, eyes position, lips and jaw
position, and lower face were analyzed in conjunction with clinical measures
collected within the National Early Warning Score. The most frequently detected
action units were action unit 43 (73%) for upper face, action unit 51 (11.7%)
for head position, action unit 62 (5.8%) for eyes position, action unit 25
(44.1%) for lips and jaw, and action unit 15 (67.6%) for lower face. The
presence of certain combined face displays was increased in patients requiring
admission to intensive care, namely, action units 43 + 15 + 25 (face display 1,
p < 0.013), action units 43 + 15 + 51/52 (face display 2, p < 0.003), and
action units 43 + 15 + 51 + 25 (face display 3, p < 0.002). Having face display
1, face display 2, and face display 3 increased the risk of being admitted to
intensive care eight-fold, 18-fold, and as a sure event, respectively. A
logistic regression model with face display 1, face display 2, face display 3,
and National Early Warning Score as independent covariates described admission
to intensive care with an average concordance statistic (C-index) of 0.71 (p =
0.009). Conclusions: Patterned facial expressions can be identified in
deteriorating general ward patients. This tool may potentially augment risk
prediction of current scoring systems.
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