scholarly journals Improving the prioritization of children at the emergency department: Updating the Manchester Triage System using vital signs

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246324
Author(s):  
Joany M. Zachariasse ◽  
Ian K. Maconochie ◽  
Ruud G. Nijman ◽  
Susanne Greber-Platzer ◽  
Frank J. Smit ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
Electronic Health Record Data ◽  
Triage System ◽  
Capillary Refill ◽  
Manchester Triage System ◽  
High Urgency

Background Vital signs are used in emergency care settings in the first assessment of children to identify those that need immediate attention. We aimed to develop and validate vital sign based Manchester Triage System (MTS) discriminators to improve triage of children at the emergency department. Methods and findings The TrIAGE project is a prospective observational study based on electronic health record data from five European EDs (Netherlands (n = 2), United Kingdom, Austria, and Portugal). In the current study, we included 117,438 consecutive children <16 years presenting to the ED during the study period (2012–2015). We derived new discriminators based on heart rate, respiratory rate, and/or capillary refill time for specific subgroups of MTS flowcharts. Moreover, we determined the optimal cut-off value for each vital sign. The main outcome measure was a previously developed 3-category reference standard (high, intermediate, low urgency) for the required urgency of care, based on mortality at the ED, immediate lifesaving interventions, disposition and resource use. We determined six new discriminators for children <1 year and ≥1 year: “Very abnormal respiratory rate”, “Abnormal heart rate”, and “Abnormal respiratory rate”, with optimal cut-offs, and specific subgroups of flowcharts. Application of the modified MTS reclassified 744 patients (2.5%). Sensitivity increased from 0.66 (95%CI 0.60–0.72) to 0.71 (0.66–0.75) for high urgency patients and from 0.67 (0.54–0.76) to 0.70 (0.58–0.80) for high and intermediate urgency patients. Specificity decreased from 0.90 (0.86–0.93) to 0.89 (0.85–0.92) for high and 0.66 (0.52–0.78) to 0.63 (0.50–0.75) for high and intermediate urgency patients. These differences were statistically significant. Overall performance improved (R2 0.199 versus 0.204). Conclusions Six new discriminators based on vital signs lead to a small but relevant increase in performance and should be implemented in the MTS.

scholarly journals Feasibility and Accuracy of a Wearable Biosensor Device for Vital Sign Monitoring in Septic Emergency Department Patients in Rwanda

2019 ◽  
Vol 34 (s1) ◽  
pp. s85-s86
Author(s):  
Stephanie Garbern ◽  
Gabin Mbanjumucyo ◽  
Christian Umuhoza ◽  
Vinay Sharma ◽  
James Mackey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
Correlation Coefficients ◽  
University Teaching ◽  
Suspected Sepsis ◽  
The Impact ◽  
Biosensor Device

Introduction:Low and middle-income countries (LMICs) bear a disproportionately high burden of sepsis, contributing to an estimated 90% of global sepsis-related deaths. Critical care capabilities needed for septic patients, such as continuous vital sign monitoring, are often unavailable in LMICs.Aim:This study aimed to assess the feasibility and accuracy of using a small wireless, wearable biosensor device linked to a smartphone, and a cloud analytics platform for continuous vital sign monitoring in emergency department (ED) patients with suspected sepsis in Rwanda.Methods:This was a prospective observational study of adult and pediatric patients (≥ 2 months) with suspected sepsis presenting to Kigali University Teaching Hospital ED. Biosensor devices were applied to patients’ chest walls and continuously recorded vital signs (including heart rate and respiratory rate) for the duration of their ED course. These vital signs were compared to intermittent, manually-collected vital signs performed by a research nurse every 6-8 hours. Pearson’s correlation coefficients were calculated over the study population to determine the correlation between the vital signs obtained from the biosensor device and those collected manually.Results:42 patients (20 adults, 22 children) were enrolled. Mean duration of monitoring with the biosensor device was 34.4 hours. Biosensor and manual vital signs were strongly correlated for heart rate (r=0.87, p<0.001) and respiratory rate (r=0.74 p<0.001). Feasibility issues occurred in 9/42 (21%) patients, although were minor and included biosensor falling off (4.8%), technical/connectivity problems (7.1%), removal by a physician (2.4%), removal for a procedure (2.4%), and patient/parent desire to remove the device (4.8%).Discussion:Wearable biosensor devices can be feasibly implemented and provide accurate continuous vital sign measurements in critically ill pediatric and adult patients with suspected sepsis in a resource-limited setting. Further prospective studies evaluating the impact of biosensor devices on improving clinical outcomes for septic patients are needed.

scholarly journals Distribution of Pediatric Vital Signs in the Emergency Department: A Nationwide Study

Children ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. 89
Author(s):  
Woori Bae ◽  
Kyunghoon Kim ◽  
Bongjin Lee
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Body Temperature ◽  
Respiratory Rate ◽  
Life Support ◽  
Vital Signs ◽  
Reference Ranges ◽  
Normal Body Temperature ◽  
Heart Rates ◽  
Normal Body

To effectively use vital signs as indicators in children, the magnitude of deviation from expected vital sign distribution should be determined. The purpose of this study is to derive age-specific centile charts for the heart rate and respiratory rate of the children who visited the emergency department. This study used the Korea’s National Emergency Department Information System dataset. Patients aged <16 years visiting the emergency department between 1 January 2016 and 31 December 2017 were included. Heart rate and respiratory rate centile charts were derived from the population with normal body temperature (36 to <38 °C). Of 1,901,816 data points retrieved from the database, 1,454,372 sets of heart rates and 1,458,791 sets of respiratory rates were used to derive centile charts. Age-specific centile charts and curves of heart rates and respiratory rates showed a decline in heart rate and respiratory rate from birth to early adolescence. There were substantial discrepancies in the reference ranges of Advanced Paediatric Life Support and Pediatric Advanced Life Support guidelines. Age-based heart rate and respiratory rate centile charts at normal body temperature, derived from children visiting emergency departments, serve as new evidence-based data and can be used in follow-up studies to improve clinical care for children.

scholarly journals Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda

2019 ◽  
Vol 5 ◽  
pp. 205520761987934
Author(s):  
Stephanie C Garbern ◽  
Gabin Mbanjumucyo ◽  
Christian Umuhoza ◽  
Vinay K Sharma ◽  
James Mackey ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
University Teaching ◽  
Suspected Sepsis ◽  
Middle Income ◽  
Radiologic Study ◽  
Emergency Department Patients ◽  
Biosensor Device

Objective Critical care capabilities needed for the management of septic patients, such as continuous vital sign monitoring, are largely unavailable in most emergency departments (EDs) in low- and middle-income country (LMIC) settings. This study aimed to assess the feasibility and accuracy of using a wireless wearable biosensor device for continuous vital sign monitoring in ED patients with suspected sepsis in an LMIC setting. Methods This was a prospective observational study of pediatric (≥2 mon) and adult patients with suspected sepsis at the Kigali University Teaching Hospital ED. Heart rate, respiratory rate and temperature measurements were continuously recorded using a wearable biosensor device for the duration of the patients’ ED course and compared to intermittent manually collected vital signs. Results A total of 42 patients had sufficient data for analysis. Mean duration of monitoring was 32.8 h per patient. Biosensor measurements were strongly correlated with manual measurements for heart rate (r = 0.87, p <  0.001) and respiratory rate (r = 0.75, p <  0.001), although were less strong for temperature (r = 0.61, p <  0.001). Mean (SD) differences between biosensor and manual measurements were 1.2 (11.4) beats/min, 2.5 (5.5) breaths/min and 1.4 (1.0)°C. Technical or practical feasibility issues occurred in 12 patients (28.6%) although were minor and included biosensor detachment, connectivity problems, removal for a radiologic study or exam, and patient/parent desire to remove the device. Conclusions Wearable biosensor devices can be feasibly implemented and provide accurate continuous heart rate and respiratory rate monitoring in acutely ill pediatric and adult ED patients with sepsis in an LMIC setting.

scholarly journals Non-contact physiological monitoring of post-operative patients in the intensive care unit

2022 ◽  
Vol 5 (1) ◽  
Author(s):  
João Jorge ◽  
Mauricio Villarroel ◽  
Hamish Tomlinson ◽  
Oliver Gibson ◽  
Julie L. Darbyshire ◽  
...  
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Vital Signs ◽  
Reference Value ◽  
Absolute Error ◽  
Video Camera ◽  
Clinical Observations ◽  
Operative Care ◽  
Respiratory Events

AbstractProlonged non-contact camera-based monitoring in critically ill patients presents unique challenges, but may facilitate safe recovery. A study was designed to evaluate the feasibility of introducing a non-contact video camera monitoring system into an acute clinical setting. We assessed the accuracy and robustness of the video camera-derived estimates of the vital signs against the electronically-recorded reference values in both day and night environments. We demonstrated non-contact monitoring of heart rate and respiratory rate for extended periods of time in 15 post-operative patients. Across day and night, heart rate was estimated for up to 53.2% (103.0 h) of the total valid camera data with a mean absolute error (MAE) of 2.5 beats/min in comparison to two reference sensors. We obtained respiratory rate estimates for 63.1% (119.8 h) of the total valid camera data with a MAE of 2.4 breaths/min against the reference value computed from the chest impedance pneumogram. Non-contact estimates detected relevant changes in the vital-sign values between routine clinical observations. Pivotal respiratory events in a post-operative patient could be identified from the analysis of video-derived respiratory information. Continuous vital-sign monitoring supported by non-contact video camera estimates could be used to track early signs of physiological deterioration during post-operative care.

scholarly journals Evaluating the Accuracy of the VitalWellness Device

Iproceedings ◽  
10.2196/16250 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e16250
Author(s):  
Nicole Polanco ◽  
Sharon Odametey ◽  
Neda Derakhshani ◽  
Mark Khachaturian ◽  
Connor Devoe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Standard Deviation ◽  
Body Temperature ◽  
Respiratory Rate ◽  
Linear Relationship ◽  
Vital Sign ◽  
Skin Color ◽  
Vital Signs ◽  
Mean Difference

Background Wellness devices for health tracking have gained popularity in recent years. Additionally, portable and readily accessible wellness devices have several advantages when compared to traditional medical devices found in clinical environments The VitalWellness device is a portable wellness device that can potentially aide vital sign measuring for those interested in tracking their health. Objective In this diagnostic accuracy study, we evaluated the performance of the VitalWellness device, a wireless, compact, non-invasive device that measures four vital signs (blood pressure (BP), heart rate (HR), respiratory rate (RR), and body temperature using the index finger and forehead. Methods Volunteers age ≥18 years were enrolled to provide blood pressure (BP), heart rate (HR), respiratory rate (RR), and body temperature. We recruited participants with vital signs that fell within and outside of the normal physiological range. A sub-group of eligible participants were asked to undergo an exercise test, aerobic step test and/or a paced breathing test to analyze the VitalWellness device’s performance on vital signs outside of the normal physiological ranges for HR and RR. Vital signs measurements were collected with the VitalWellness device and FDA-approved reference devices. Mean, standard deviation, mean difference, standard deviation of difference, standard error of mean difference, and correlation coefficients were calculated for measurements collected; these measurements were plotted on a scatter plot and a Bland-Altman plot. Sensitivity analyses were performed to evaluate the performance of the VitalWellness device by gender, skin color, finger size, and in the presence of artifacts. Results 265 volunteers enrolled in the study and 2 withdrew before study completion. Majority of the volunteers were female (62%), predominately white (63%), graduated from college or post college (67%), and employed (59%). There was a moderately strong linear relationship between VitalWellness BP and reference BP (r=0.7, P<.05) and VitalWellness RR and reference RR measurements (r=0.7, P<.05). The VitalWellness HR readings were significantly in line with the reference HR readings (r=0.9, P<.05). There was a weaker linear relationship between VitalWellness temperature and reference temperature (r=0.3, P<.05). There were no differences in performance of the VitalWellness device by gender, skin color or in the presence of artifacts. Finger size was associated with differential performance for RR. Conclusions Overall, the VitalWellness device performed well in taking BP, HR, and RR when compared to FDA-approved reference devices and has potential serve as a wellness device. To test adaptability and acceptability, future research may evaluate user’s interactions and experiences with the VitalWellness device at home. In addition, the next phase of the study will evaluate transmitting vital sign information from the VitalWellness device to an online secured database where information can be shared with HCPs within seconds of measurement.

scholarly journals 2319. Clinical Predictors of Influenza and Hospitalization of Children with Influenza in an Emergent Care Setting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S795-S796
Author(s):  
Suchitra Rao ◽  
Molly Lamb ◽  
Angela Moss ◽  
Emad Yanni ◽  
Rafik Bekkat-Berkani ◽  
...  
Keyword(s):  
Heart Rate ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Influenza Infection ◽  
Vital Signs ◽  
Urgent Care ◽  
Peak Heart Rate ◽  
Initial Oxygen ◽  
Z Scores

Abstract Background Objective measures utilizing early vital sign data show promise in predicting more severe outcomes among adults with influenza, but data are sparse in children. The objectives of this study were to determine the value of vital signs in predicting influenza infection or hospitalization due to influenza infection among children evaluated in an emergency department (ED) or urgent care (UC) setting in Colorado. Methods We evaluated vital signs obtained from a prospective cohort study of children aged 6 months to 8 years of age with influenza like illness evaluated at an ED/UC site in Aurora, CO from 2016–2018, and who underwent influenza testing by PCR. We collected the first set of vital signs, peak heart rate and temperature, and converted heart rate (HR) and respiratory rate (RR) to z-scores by age. HR z scores were further adjusted for temperature. Bivariable analyses for each vital sign as a predictor of influenza-related hospitalization and influenza infection as main outcomes were conducted. Predictors with P < 0.2 were entered into a multivariable logistic regression model to determine odds ratios (OR) and 95% CI; model performance was assessed using the Brier score and discriminative ability with the C statistic. Results Among 1478 children, 411 were positive for influenza, of which 28 were hospitalized. In multivariable analyses, among children with influenza infection, lower initial oxygen saturation (OR 0.87, 95% CI 0.78–0.98, P = 0.026) and higher adjusted respiratory rate (OR 2.09, 95% CI 1.21–3.61, P = 0.0085) were significant predictors of hospitalization (Figure 1). Among children with ILI, higher peak temperature (OR 1.46, 95% CI 1.30–1.63, P < 0.0001), lower adjusted peak heart rate (OR 0.79, 95% CI 0.69–0.90, P = 0.0005), higher initial oxygen saturation (OR 1.07, 95% CI 1.03–1.12 P = 0.002) and lower adjusted respiratory rate (OR 0.74, 95% CI 0.64–0.87, P = 0.0002) were significant predictors for having PCR-confirmed influenza. However, this model had poor calibration and discriminatory ability. Conclusion Higher respiratory rate adjusted for age and lower initial oxygen saturation were significant predictors of hospitalization among young children with PCR-confirmed influenza, but were not reliable discriminators of having influenza infection. Disclosures All authors: No reported disclosures.

scholarly journals Management of children visiting the emergency department during out-of-office hours: an observational study

2020 ◽  
Vol 4 (1) ◽  
pp. e000687
Author(s):  
Gina Schinkelshoek ◽  
Dorine M Borensztajn ◽  
Joany M Zachariasse ◽  
Ian K Maconochie ◽  
Claudio F Alves ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Paediatric Intensive Care Unit ◽  
Vital Signs ◽  
Patient Characteristics ◽  
Electronic Health Record Data ◽  
Manchester Triage System ◽  
Record Data ◽  
Seriously Ill ◽  
Night Shifts

BackgroundThe aim was to study the characteristics and management of children visiting the emergency department (ED) during out-of-office hours.MethodsWe analysed electronic health record data from 119 204 children visiting one of five EDs in four European countries. Patient characteristics and management (diagnostic tests, treatment, hospital admission and paediatric intensive care unit admission) were compared between children visiting during office hours and evening shifts, night shifts and weekend day shifts. Analyses were corrected for age, gender, Manchester Triage System urgency, abnormal vital signs, presenting problems and hospital.ResultsPatients presenting at night were younger (median (IQR) age: 3.7 (1.4–8.2) years vs 4.8 (1.8–9.9)), more often classified as high urgent (16.3% vs 9.9%) and more often had ≥2 abnormal vital signs (22.8% vs 18.1%) compared with office hours. After correcting for disease severity, laboratory and radiological tests were less likely to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78–0.86 and aOR: 0.64, 95% CI 0.60–0.67, respectively); treatment was more likely to be undertaken (aOR: 1.56, 95% CI 1.49–1.63) and patients were more likely to be admitted to the hospital (aOR: 1.32, 95% CI 1.24–1.41) at night. Patterns in management during out-of-office hours were comparable between the different hospitals, with variability remaining.ConclusionsChildren visiting during the night are relatively more seriously ill, highlighting the need to keep improving emergency care on a 24-hour-a-day basis. Further research is needed to explain the differences in management during the night and how these differences affect patient outcomes.

scholarly journals Feasibility of continuous monitoring of vital signs in surgical patients on a general ward: an observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042735
Author(s):  
Jobbe P L Leenen ◽  
Eline M Dijkman ◽  
Joris D van Dijk ◽  
Henderik L van Westreenen ◽  
Cor Kalkman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cohort Study ◽  
Respiratory Rate ◽  
Vital Sign ◽  
Continuous Monitoring ◽  
Vital Signs ◽  
Observational Cohort Study ◽  
General Ward ◽  
Surgical Patients ◽  
Observational Cohort

ObjectiveTo determine feasibility, in terms of acceptability and system fidelity, of continuous vital signs monitoring in abdominal surgery patients on a general ward.DesignObservational cohort study.SettingTertiary teaching hospital.ParticipantsPostoperative abdominal surgical patients (n=30) and nurses (n=23).InterventionsPatients were continuously monitored with the SensiumVitals wearable device until discharge in addition to usual care, which is intermittent Modified Early Warning Score measurements. Heart rate, respiratory rate and axillary temperature were monitored every 2 min. Values and trends were visualised and alerts sent to the nurses.OutcomesSystem fidelity was measured by analysis of the monitoring data. Acceptability by patients and nurses was assessed using questionnaires.ResultsThirty patients were monitored for a median duration of 81 hours (IQR 47–143) per patient, resulting in 115 217 measurements per parameter. In total, 19% (n=21 311) of heart rate, 51% (n=59 184) of respiratory rate and 9% of temperature measurements showed artefacts (n=10 269). The system algorithm sent 972 alerts (median alert rate of 4.5 per patient per day), of which 90.3% (n=878) were system alerts and 9.7% (n=94) were vital sign alerts. 35% (n=33) of vital sign alerts were true positives. 93% (n=25) of patients rated the patch as comfortable, 67% (n=18) felt safer and 89% (n=24) would like to wear it next time in the hospital. Nurses were neutral about usefulness, with a median score of 3.5 (IQR 3.1–4) on a 7-point Likert scale, ease of use 3.7 (IQR 3.2–4.8) and satisfaction 3.7 (IQR 3.2–4.8), but agreed on ease of learning at 5.0 (IQR 4.0–5.8). Neutral scores were mostly related to the perceived limited fidelity of the system.ConclusionsContinuous monitoring of vital signs with a wearable device was well accepted by patients. Nurses’ ratings were highly variable, resulting in on average neutral attitude towards remote monitoring. Our results suggest it is feasible to monitor vital signs continuously on general wards, although acceptability of the device among nurses needs further improvement.

scholarly journals Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Gideon H. P. Latten ◽  
Judith Polak ◽  
Audrey H. H. Merry ◽  
Jean W. M. Muris ◽  
Jan C. Ter Maaten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Respiratory Rate ◽  
Early Warning ◽  
Vital Sign ◽  
Vital Signs ◽  
Early Warning Score ◽  
Suspected Infection ◽  
Prospective Multicentre Study ◽  
Clinical Rules ◽  
Clinical Rule

Abstract Background For emergency department (ED) patients with suspected infection, a vital sign-based clinical rule is often calculated shortly after the patient arrives. The clinical rule score (normal or abnormal) provides information about diagnosis and/or prognosis. Since vital signs vary over time, the clinical rule scores can change as well. In this prospective multicentre study, we investigate how often the scores of four frequently used clinical rules change during the ED stay of patients with suspected infection. Methods Adult (≥ 18 years) patients with suspected infection were prospectively included in three Dutch EDs between March 2016 and December 2019. Vital signs were measured in 30-min intervals and the quick Sequential Organ Failure Assessment (qSOFA) score, the Systemic Inflammatory Response Syndrome (SIRS) criteria, the Modified Early Warning Score and the National Early Warning Score (NEWS) score were calculated. Using the established cut-off points, we analysed how often alterations in clinical rule scores occurred (i.e. switched from normal to abnormal or vice versa). In addition, we investigated which vital signs caused most alterations. Results We included 1433 patients, of whom a clinical rule score changed once or more in 637 (44.5%) patients. In 6.7–17.5% (depending on the clinical rule) of patients with an initial negative clinical rule score, a positive score occurred later during ED stay. In over half (54.3–65.0%) of patients with an initial positive clinical rule score, the score became negative later on. The respiratory rate caused most (51.2%) alterations. Conclusion After ED arrival, alterations in qSOFA, SIRS, MEWS and/or NEWS score are present in almost half of patients with suspected infection. The most contributing vital sign to these alterations was the respiratory rate. One in 6–15 patients displayed an abnormal clinical rule score after a normal initial score. Clinicians should be aware of the frequency of these alterations in clinical rule scores, as clinical rules are widely used for diagnosis and/or prognosis and the optimal moment of assessing them is unknown.

scholarly journals Associação entre sinais vitais e Sistema Manchester de Triagem: estudo observacional retrospectivo

2018 ◽  
Vol 16 (4) ◽  
pp. 379
Author(s):  
José Carlos Amado Martins ◽  
Helisamara Mota Guedes ◽  
Cristiane Chaves de Souza ◽  
Tânia Couto Machado Chianca
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Heart Rate ◽  
Observational Study ◽  
Pain Intensity ◽  
Vital Signs ◽  
Manchester Triage System ◽  
Risk Levels ◽  
Exposure Factor ◽  
The Mean

Aim: To evaluate the association between vital signs collected at the patient's entrance to the emergency department and the risk levels of the Manchester Triage System (MTS). Method: This is a retrospective observational study; whose sample was 154,714 patients. The exposure factor was the vital signs data, and the primary endpoint was the level of risk of MTS. Statistical, descriptive and inferential analyzes were conducted. Results: The most evaluated vital data was pain intensity; blood pressure was the least evaluated. Changes in heart rate to more or less of physiological patterns have increased the clinical priority of patients. Discussion: The higher the level of severity of MTS, the greater the variability of the mean of the vital signs evaluated. Conclusion: More severe patients tend to present greater variation in terms of vital signs on admission to the emergency department.

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