scholarly journals P044: Use of a gait tracking device to count steps of older emergency department patient

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S78-S79
Author(s):  
J. Estrada-Codecido ◽  
J. Lee
Keyword(s):  
Emergency Department ◽  
Preliminary Data ◽  
Prospective Observational Study ◽  
Eligible Patient ◽  
Functional Decline ◽  
Emergency Department Patient ◽  
Step Count ◽  
Potential Marker ◽  
Tracking Device ◽  
Tracking Devices

Introduction: Delirium is a common complication among older people who need care in the emergency department (ED). Mobility is an evidence-based non-pharmacologic strategy shown to reduce delirium and functional decline among older patients in the acute care setting. However, previous research has shown that compliance with mobility is important to achieve this decreased incidence of delirium. Gait tracking devices have been used in previous studies to accurately measure steps, engagement and intensity of physical activity in older hospitalized patients.The objectives of this study are to compare the feasibility and validate the accuracy of three accelerometer-based gait tracking devices. This is the first step in a program of research to objectively measure mobility among older ED patients as a potential marker of delirium risk. Methods: This is a prospective, observational study of patients 65 years of age and older during their ED visit. We excluded those with critical illness, unable to communicate or provide consent (language barrier, aphasia); and those with any ambulatory impediments. Consenting participants wear the gait trackers for the duration of their stay or for a minimum of 8 hour, and ambulate as normally as they would in their home. Devices were retrieved when the patient was admitted, discharged or, after 8 hours and the steps count was then recorded from an online interface. Our primary feasibility measure is the proportion of eligible patient for which we are be able to recover the tracker and record their steps. The primary validation endpoint will be the concordance between steps recorded by the gait tracking device compared to a gold standard manual step count over a fixed distance. We will report proportions with exact binomial 95% confidence intervals (CI) for feasibility and validity endpoints. Results: Preliminary data from an initial pilot phase includes 7 participants who wore a gait tracking device during their ED visit. Mean age was 79.7 years (+/−5.76) and 57% were females. Devices were worn by participants and recovered by research staff in all 7 cases (100%, 95% CI: 59 – 100). Data from online interface has been collected from 6 participants (85%, 95%CI: 42 – 99). Mean step count by observer was 86.17 +/− 4 (95% CI 82.2 – 90.2) and 70.3 +/− 4 (95%CI 66-74.3) by gait tracker. Conclusion: Our preliminary data suggests that use of gait-tracking devices in the ED is feasible.

scholarly journals P107: Use of activity trackers to count steps of older emergency department patients: a feasibility and validity study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S103-S103
Author(s):  
J. Estrada-Codecido ◽  
J. Lee ◽  
M. Chignell ◽  
C. Whyne
Keyword(s):  
Gold Standard ◽  
Eligible Patient ◽  
Intraclass Correlation ◽  
Functional Decline ◽  
Activity Trackers ◽  
Potential Marker ◽  
Final Estimate ◽  
Emergency Department Patients ◽  
A Prospective Study ◽  
Tracking Devices

Introduction: Mobility is an evidence-based non-pharmacologic strategy shown to reduce delirium and functional decline among older patients in the acute care setting. Activity trackers have been used in previous studies to objectively measure mobility in older hospitalized patients. This study aims to compare the feasibility and validate the accuracy of three accelerometer-based activity trackers (Fitbit Zip, Fitbit Charge HR and StepWatch). This is the first step in a program of research to objectively measure as a potential marker of delirium risk. Methods: This is a prospective study of patients 65 years of age and older during their ED visit. We excluded those with critical illness, unable to communicate or provide consent; and any ambulatory impediments. Consenting participants wore the trackers for up to 8 hour, and completed a 6-meter walk test while a research assistant manually counted their steps. Our primary feasibility measure was the proportion of eligible patient for which we were able to recover the tracker and recorded their steps. The primary validation endpoint was the concordance between steps recorded by the tracker compared to a gold standard manual step count over a fixed distance. Sample size was based on the desired precision of the final estimate of feasibility. Intraclass correlation coefficient (ICC) was calculated to assess agreements between devices and manual count. We will report proportions with exact binomial 95% confidence intervals (CI) for feasibility and validity endpoints. Results: 41 participants were enrolled in this study. Mean age was 74.6 years (+/- 5.76) and 59% were females. The total subjects that wore the Fitbit Zip, Fitbit Charge HR and StepWatch during study participation was, 40/41 (97.5%, CI 0.87–0.99), 33/34 (97%, CI 0.84–0.99) and 31/32 (96.8%, CI 0.83–0.99), respectively. Total subjects with completed data extracted from the Fitbit Zip, Fitbit Charge HR and StepWatch was, 38/41 subjects (92.6%, CI 0.80–0.98), 34 (100%, CI 0.89–1.00), and 32 (100%, CI 0.89–1.00), respectively. All devices were recovered after use (100%, 95%CI 0.91–100). Conclusion: Our results suggest: 1) the use of gait-tracking devices in the ED is feasible, 2) consumer and research-grade devices showed good validity against the gold standard, and 3) the use of small, inexpensive, consumer-grade trackers to objectively measure mobility of older adults in the ED.

Geriatrische revalidatiezorg na triage op de Spoedeisende Hulp: Patiëntkarakteristieken en revalidatie-uitkomsten

2019 ◽  
Keyword(s):  
Emergency Department ◽  
Residential Care ◽  
Functional Decline ◽  
Care Facility ◽  
Geriatric Rehabilitation ◽  
Residential Care Facility ◽  
Successful Group ◽  
Geriatrische Revalidatiezorg ◽  
One Year ◽  
Single Contact

In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.

Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

2021 ◽  
Author(s):  
Karoline Stentoft Rybjerg Larsen ◽  
Marianne Lisby ◽  
Hans Kirkegaard ◽  
Annemette Krintel Petersen
Keyword(s):  
Emergency Department ◽  
Electronic Patient Record ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Patient Characteristics ◽  
Risk Of Death ◽  
Record Data ◽  
Emergency Department Patients ◽  
One Year ◽  
Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

scholarly journals The Recreational Trail of the El Caminito del Rey Natural Tourist Attraction, Spain: Determination of Hikers’ Flow

2021 ◽  
Vol 18 (4) ◽  
pp. 1809
Author(s):  
Gemma María Gea-García ◽  
Carmelo Fernández-Vicente ◽  
Francisco J. Barón-López ◽  
Jesús Miranda-Páez
Keyword(s):  
Eye Tracking ◽  
Circulation Pattern ◽  
Travel Speed ◽  
Outdoor Activity ◽  
Efficient Management ◽  
Exponential Increase ◽  
The Mean ◽  
Tracking Device ◽  
Tracking Devices

Hiking is a very popular outdoor activity, and has led to an exponential increase in the number of visitors to natural spaces. The objective of this study was to analyze the circulation pattern of visitors to the Caminito del Rey trail, based on the three zones into which the trail can be divided. The sample consisted of 1582 hikers distributed into three different profiles. Of these, 126 utilized an eye-tracking device during the hike, while, for the rest (1456), only their travel speed along the trail was recorded. The use of eye tracking devices identified a greater number of interesting landscapes located in zones 1 and 3 of the trail, and it was observed that the mean travel speed was greater for zone 2 (42.31 m/min) (p < 0.01). Additionally, when the three different visitor profiles were analyzed, significant differences were found between the mean travel speeds according to sectors (p < 0.05). This information is crucial for more efficient management of the trail, as it allows for the development of measures to control and regulate the flow of visitors according to zone, and the design of additional strategies to increase the awareness of the hiker about specific areas of the hike.

scholarly journals Delirium in the Older Emergency Department Patient: A Quiet Epidemic

2010 ◽  
Vol 28 (3) ◽  
pp. 611-631 ◽  
Author(s):  
Jin H. Han ◽  
Amanda Wilson ◽  
E. Wesley Ely
Keyword(s):  
Emergency Department ◽  
Emergency Department Patient

scholarly journals LO028: Prospective validation of an iOS app to evaluate tremor in patients with alcohol withdrawal syndrome

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S39-S39 ◽  
Author(s):  
B. Borgundvaag ◽  
S.L. McLeod ◽  
T.E. Dear ◽  
S.M. Carver ◽  
N. Norouzi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Prospective Observational Study ◽  
Alcohol Withdrawal Syndrome ◽  
Research Assistant ◽  
Rater Agreement ◽  
Objective Indicator ◽  
Expert Assessments

Introduction: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom driven approach, whereby patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised; CIWA-Ar) and treated according to severity. Among the domains assessed by the CIWA-Ar, tremor is the most objective indicator of withdrawal severity, however, the ability of clinicians to reliably quantify tremor is highly dependent on experience. The objective of this study was to prospectively validate an objective, reliable tool to standardize and quantify the severity of alcohol withdrawal tremor using the built-in accelerometer of an iOS application. Methods: A prospective observational study of patients ≥18 years presenting to an academic emergency department in alcohol withdrawal was conducted from Oct 2014 to Aug 2015. Assessments were videotaped by a research assistant and subsequently reviewed by 3 clinical experts, blinded to the primary clinical assessment. Tremor severity was scored using the 8-point CIWA scale (0=no tremor, 7=severe tremor). Accelerometer derived results were compared to expert assessments of each video. Inter-rater agreement was estimated using Cohen’s kappa (k) statistic. Results: 76 patients with 78 tremor recordings were included. Accelerometer derived tremor scores matched exactly with expert assessor scores in 36 (46.2%) cases, within 1 point for 73 (93.6%) cases and differed by ≥ 2 points in 5 (6.4%) cases. The overall kappa for agreement within 1 point for tremor severity was ‘very good’ 0.92 (95% CI: 0.86, 0.99). Conclusion: iOS accelerometer based assessment of the tremor component of the CIWA-Ar score is reliable and has potential to more accurately assess the severity of patients in alcohol withdrawal. We anticipate this resource will be easily disseminated and will impact and improve the care of patients with alcohol withdrawal.

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