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

 

by Carlos Areia, Christopher Biggs, Mauro Santos, Neal Thurley, Stephen Gerry, Lionel Tarassenko, Peter Watkinson and Sarah Vollam 

 

Critical Care volume 25, Article number: 351; Published: 28 September 2021

 

Background

Timely recognition of the deteriorating inpatient remains challenging. Wearable monitoring systems (WMS) may augment current monitoring practices. However, there are many barriers to implementation in the hospital environment, and evidence describing the clinical impact of WMS on deterioration detection and patient outcome remains unclear.

Objective

To assess the impact of vital-sign monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using WMS, in comparison with standard care.

Methods

A systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL, Health Technology Assessment databases and grey literature. Studies comparing the use of WMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information.

Results

Of 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the WMS, when compared with standard care, was not associated with significant reductions in intensive care transfers (risk ratio, RR 0.87; 95% confidence interval, CI 0.66–1.15), rapid response or cardiac arrest team activation (RR 0.84; 95% CI 0.69–1.01), total (RR 0.77; 95% CI 0.44–1.32) and major (RR 0.55; 95% CI 0.24–1.30) complications prevalence. There was also no statistically significant association with reduced mortality (RR 0.48; 95% CI 0.18–1.29) and hospital length of stay (mean difference, MD − 0.09; 95% CI − 0.43 to 0.44).

Conclusion

This systematic review indicates that there is no current evidence that implementation of WMS impacts early deterioration detection and associated clinical outcomes, as differing design/quality of available studies and diversity of outcome measures make it difficult to reach a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alarms and promote rapid clinical action in response to deterioration.

What Faces Reveal: A Novel Method to Identify Patients at Risk of Deterioration Using Facial Expressions*

What Faces Reveal: A NovelMethod to Identify Patients at Risk of Deterioration Using Facial Expressions*

by Madrigal-Garcia, Maria Isabel; Rodrigues, Marcos; Shenfield, Alex; Singer, Mervyn; Moreno-Cuesta, Jeronimo  

Critical Care Medicine: July 2018 - Volume 46 - Issue 7 - p 1057–1062

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.

Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals

Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review. Critical Care, 2015, 19: 230

Douw, G., et al.

http://ccforum.com/content/pdf/s13054-015-0950-5.pdf

 Nurses often recognize deterioration in patients through intuition rather than through routine vital signs measurement. Adding the ‘worry/concern’ sign to the Rapid Response System provides opportunities for nurses to act upon their intuitive feelings. Identifying what triggers nurses to be ‘worried/concerned’ might help to put intuition into words and potentially empower nurses to act upon their intuitive feelings and obtain medical assistance in an early stage of deterioration. The aim of this systematic review is to identify the signs and symptoms that trigger nurses’ ‘worry/concern’ about a patients’ condition. Method We searched the databases Pubmed, CINAHL, Psychinfo and Cochrane Library (Clinical Trials) using synonyms related to the three concepts:“nurses”, “worry/concern” and “deterioration”. We included studies concerning adult patients on general wards in acute care hospitals. The search was performed from start of the databases until February 14, 2014. Results: The search resulted in 4006 references, 18 studies (5 quantitative, 9 qualitative and 4 mixed-methods designs) were included in the review. Thirty-seven signs and symptoms reflecting the nature of ‘worry/concern’, emerged from the data and were summarized in 10 general indicators. ‘Worry/concern’ can be present both with or without change in vital signs. Conclusions: The signs and symptoms we found in the literature reflect the nature of nurses’ ‘worry/concern’ and nurses may incorporate these signs in their assessment of the patient and the decision to call for assistance. Its presence before vital signs have changed, suggests potential for improving care in an early stage of deterioration.