The Mechanisms Responsible for Improved Information Transfer in Avatar-Based Patient Monitoring: Multicenter Comparative Eye-Tracking Study

Background Patient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring. Objective We aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring. Methods In this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants’ visual fixations of vital signs between the two technologies. Results Participants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, P<.001; median of differences=3, 95% CI 3-4). In multivariable linear regression, monitoring technology (conventional versus avatar-based monitoring, difference=−3.3, P<.001) was an independent predictor of the number of visually fixated vital signs. The difference was less prominent in the longer (10-second) scenarios (difference=−1.5, P=.04). Study center, profession, gender, and scenario order did not influence the differences between methods. In all four scenarios, the participants visually fixated 9 of 11 vital signs statistically significantly longer using the avatar (all P<.001). Four critical vital signs (pulse rate, blood pressure, oxygen saturation, and respiratory rate) were visible almost the entire time of a scenario with the avatar; these were only visible for fractions of the observations with conventional monitoring. Visual fixation of a certain vital sign was associated with the correct perception of that vital sign in both technologies (avatar: phi coefficient=0.358; conventional monitoring: phi coefficient=0.515, both P<.001). Conclusions This eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar’s body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring.

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The Mechanisms Responsible for Improved Information Transfer in Avatar-Based Patient Monitoring: Multicenter Comparative Eye-Tracking Study (Preprint)

10.2196/preprints.15070 ◽

2019 ◽

Cited By ~ 2

Author(s):

David Werner Tscholl ◽

Julian Rössler ◽

Lucas Handschin ◽

Burkhardt Seifert ◽

Donat R Spahn ◽

...

Keyword(s):

Eye Tracking ◽

Oxygen Saturation ◽

Vital Sign ◽

Skin Color ◽

Information Transfer ◽

Patient Monitoring ◽

Vital Signs ◽

Virtual Patient ◽

Anesthesia Providers ◽

Phi Coefficient

BACKGROUND Patient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring. OBJECTIVE We aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring. METHODS In this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants’ visual fixations of vital signs between the two technologies. RESULTS Participants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, P<.001; median of differences=3, 95% CI 3-4). In multivariable linear regression, monitoring technology (conventional versus avatar-based monitoring, difference=−3.3, P<.001) was an independent predictor of the number of visually fixated vital signs. The difference was less prominent in the longer (10-second) scenarios (difference=−1.5, P=.04). Study center, profession, gender, and scenario order did not influence the differences between methods. In all four scenarios, the participants visually fixated 9 of 11 vital signs statistically significantly longer using the avatar (all P<.001). Four critical vital signs (pulse rate, blood pressure, oxygen saturation, and respiratory rate) were visible almost the entire time of a scenario with the avatar; these were only visible for fractions of the observations with conventional monitoring. Visual fixation of a certain vital sign was associated with the correct perception of that vital sign in both technologies (avatar: phi coefficient=0.358; conventional monitoring: phi coefficient=0.515, both P<.001). CONCLUSIONS This eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar’s body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring.

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Design and Improving Vital Sign with Parameter Body Temperature (axilla) and Oxymetry for Patient Monitoring

Journal of Electronics, Electromedical Engineering, and Medical Informatics ◽

10.35882/jeeemi.v2i2.4 ◽

2020 ◽

Vol 2 (2) ◽

pp. 58-64

Author(s):

Mohamad Adam Firdaus ◽

Andjar Pudji ◽

Muhammad Ridha Mak'ruf

Keyword(s):

Body Temperature ◽

Oxygen Saturation ◽

Vital Sign ◽

Medical Service ◽

Vital Signs ◽

Measuring Instruments ◽

Dressing Tool ◽

Number Of Patients ◽

Quality Of Patient Care

In most hospitals, nurses routinely calculate and document primary vital signs for all patients 2-3 times per day to get information on the patient's condition. Vital Sign Monitor is made for medical devices that can diagnose patients who need intensive care to determine patient needs. Some parameters used in patient renewal: Oxygen saturation (SPO2), and body temperature. This makes additional tasks very important to be evaluated for medical staff and equipment manufacturers. This evaluation is needed to get the real condition of the patient. With the large number of patients who need evaluation, it is not possible to see the condition of some medical workers who work. This medical service is expected to reduce the workload of nurses with doctors and improve the quality of patient care. The large demand for these devices, mostly in hospital intensive rooms, is the basis for researching the output of data from multiple vital sensor monitor monitors to obtain accurate and precise outputs. The output of the two sensors is processed by Arduino Mega2560 and requested on a 5 inch TFT LCD in the form of body temperature and oxygen saturation. Comparison of module results with standard measuring instruments calibrated to reference this module is used for accurate and precise results. According to the assessment and reversing tool data with the dressing tool, the highest error value is 1%. With a maximum permitted permission of 5%.

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Evaluating the Accuracy of an Integrated Vital Sign Measurement Wellness Device

Iproceedings ◽

10.2196/15203 ◽

2019 ◽

Vol 5 (1) ◽

pp. e15203

Author(s):

Nicole Polanco ◽

Sharon Odametey ◽

Neda Derakhshani ◽

Mark Khachaturian ◽

Connor Devoe ◽

...

Keyword(s):

Standard Deviation ◽

Linear Relationship ◽

Health Care Providers ◽

Vital Sign ◽

Skin Color ◽

Vital Signs ◽

Mean Difference ◽

Step Test ◽

Sensitivity Analyses ◽

Care Providers

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. Building tools for patients to manage their health independently may benefit their health in the long run by improving health care providers’ (HCPs) awareness of their patients’ health information outside of the clinic. Increased access to portable wellness devices that track vital signs may increase how patients and HCPs track and monitor chronic conditions which can improve health outcomes. The VitalWellness is a portable wellness device that can potentially aid vital sign measuring for those interested in tracking their health. Objective In this diagnostic accuracy study, we evaluated the clinical performance of the VitalWellness, a wireless, compact, non-invasive device that measures four vital signs using the index finger and forehead against reference vital signs devices used in the hospital setting. Methods Volunteers age ≥18 years were enrolled to provide blood pressure (BP), heart rate (HR), respiratory rate (RR), and body temperature. We recruited volunteers with vital signs that fell within and outside of the normal physiological range, depending on the measurements they consented to undergo. A subgroup of eligible volunteers 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 We enrolled 265 volunteers in the study and 2 withdrew before study completion. The majority of 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 bewteen 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.

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A preliminary assessment of vital-signs-integrated patient-assisted intravenous opioid analgesia (VPIA) for postsurgical pain

10.21203/rs.2.11609/v5 ◽

2020 ◽

Author(s):

Ban Leong SNG ◽

Daryl Jian'an Tan ◽

Chin Wen TAN ◽

Nian-Lin Reena HAN ◽

Rehena SULTANA ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Relief ◽

Oxygen Saturation ◽

Vital Sign ◽

Infusion Pump ◽

Vital Signs ◽

Oxygen Desaturation ◽

Opioid Analgesia ◽

Median Percentage ◽

Vital Signs Monitoring

Abstract Background: We developed a Vital-signs-integrated Patient-assisted Intravenous opioid Analgesia (VPIA) analgesic infusion pump, a closed-loop vital signs monitoring and drug delivery system which embodied in a novel algorithm that took into account patients’ vital signs (oxygen saturation, heart rate). The system aimed to allow responsive titration of personalized pain relief to optimize pain relief and reduce the risk of respiratory depression. Moreover, the system would be important to enable continuous monitoring of patients during delivery of opioid analgesia.Methods: Nineteen patients who underwent elective gynecological surgery with postoperative patient controlled analgesia (PCA) with morphine were recruited. The subjects were followed up from their admission to the recovery room/ ward for at least 24 hours until assessment of patient satisfaction on the VPIA analgesic infusion pump.Results: The primary outcome measure of incidence of oxygen desaturation showed all patients had at least one episode of oxygen desaturation (<95%) during the study period. Only 6 (31.6%) patients had oxygen desaturation that persisted for more than 5 minutes. The median percentage time spent during treatment that oxygen saturation fell below 95% was 1.9%. Fourteen (73.7%) out of 19 patients encountered safety pause, due to transient oxygen desaturation or bradycardia. The patients’ median [IQR] pain scores at rest and at movement after post-op 24 hours were 0.0 [2.0] and 3.0 [2.0], respectively. The average morphine consumption in the first 24 hours was 12.5 ± 7.1mg. All patients were satisfied with their experience with the VPIA analgesic infusion pump. Conclusions: The use of VPIA analgesic infusion pump, when integrated with continuous vital sign monitor and variable lockout algorithm, was able to provide pain relief with good patient satisfaction.Keywords: infusion pump, postoperative pain, vital sign monitoring, oxygen desaturation.Trial registration: This study was registered on clinicaltrials.gov registry (NCT02804022) on 28 Feb 2016.

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Comparing Classroom Instruction to Individual Instruction as an Approach to Teach Avatar-Based Patient Monitoring With Visual Patient: Simulation Study (Preprint)

10.2196/preprints.17922 ◽

2020 ◽

Cited By ~ 1

Author(s):

Julian Rössler ◽

Alexander Kaserer ◽

Benjamin Albiez ◽

Julia Braun ◽

Jan Breckwoldt ◽

...

Keyword(s):

Large Scale ◽

Patient Monitoring ◽

Vital Signs ◽

Care Providers ◽

Instruction Group ◽

Anesthesia Providers ◽

Individual Instruction ◽

Significant Difference ◽

Historical Sample ◽

Class Instruction

BACKGROUND Visual Patient is an avatar-based alternative to standard patient monitor displays that significantly improves the perception of vital signs. Implementation of this technology in larger organizations would require it to be teachable by brief class instruction to large groups of professionals. Therefore, our study aimed to investigate the efficacy of such a large-scale introduction to Visual Patient. OBJECTIVE In this study, we aimed to compare 2 different educational methods, one-on-one instruction and class instruction, for training anesthesia providers in avatar-based patient monitoring. METHODS We presented 42 anesthesia providers with 30 minutes of class instruction on Visual Patient (class instruction group). We further selected a historical sample of 16 participants from a previous study who each received individual instruction (individual instruction group). After the instruction, the participants were shown monitors with either conventional displays or Visual Patient displays and were asked to interpret vital signs. In the class instruction group, the participants were shown scenarios for either 3 or 10 seconds, and the numbers of correct perceptions with each technology were compared. Then, the teaching efficacy of the class instruction was compared with that of the individual instruction in the historical sample by 2-way mixed analysis of variance and mixed regression. RESULTS In the class instruction group, when participants were presented with the 3-second scenario, there was a statistically significant median increase in the number of perceived vital signs when the participants were shown the Visual Patient compared to when they were shown the conventional display (3 vital signs, P<.001; effect size –0.55). No significant difference was found for the 10-second scenarios. There was a statistically significant interaction between the teaching intervention and display technology in the number of perceived vital signs (P=.04; partial η2=.076). The mixed logistic regression model for correct vital sign perception yielded an odds ratio (OR) of 1.88 (95% CI 1.41-2.52; P<.001) for individual instruction compared to class instruction as well as an OR of 3.03 (95% CI 2.50-3.70; P<.001) for the Visual Patient compared to conventional monitoring. CONCLUSIONS Although individual instruction on Visual Patient is slightly more effective, class instruction is a viable teaching method; thus, large-scale introduction of health care providers to this novel technology is feasible.

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Multiple Patient Monitoring in High Dependency Units: A Field Study

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181319631326 ◽

2019 ◽

Vol 63 (1) ◽

pp. 669-669

Author(s):

Marie-Lys F. A. Deschamps ◽

Penelope M. Sanderson

Keyword(s):

Critical Care ◽

Simulation Study ◽

Vital Sign ◽

Patient Monitoring ◽

Vital Signs ◽

Well Being ◽

Alarm Fatigue ◽

Critical Care Units ◽

High Dependency ◽

Australian Hospital

Much of the focus related to alarm fatigue has been directed towards reducing the number of alarms associated with vital sign monitoring. However, recent fieldwork conducted in four high dependency and critical care units of an Australian hospital suggests that the most problematic alarms were often unassociated with vital signs, such as IV pumps and mattress alarms. Many nurses indicated that they like alarms, even when false, because they support awareness of their patients’ well-being. Results of the fieldwork are guiding the design of a simulation study investigating clinical monitoring displays.

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Prospective Pilot Study of Telehealth As Domiciliary Follow-up after Hematopoietic Cell Transplantation during the COVID19 Pandemic

Blood ◽

10.1182/blood-2020-138780 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 35-36

Author(s):

Alberto Mussetti ◽

Maria Queralt Salas Gay ◽

Maria Condom ◽

Maite Antonio ◽

Cristian Ochoa ◽

...

Keyword(s):

Blood Pressure ◽

Oxygen Saturation ◽

Real Time ◽

Emotional Distress ◽

Patient Monitoring ◽

Clinical Symptoms ◽

Vital Signs ◽

Clinical Information ◽

Patient Monitoring System

Introduction An increased risk of mortality has been documented in transplanted patients affected by Coronavirus Disease 2019 (COVID19) with an estimated mortality rate between 20-40%. Multiple efforts are ongoing to control COVID19 pandemic, and clinical practice is being adapted at the same time as the pandemic progresses around the world. To reduce unnecessary in-person appointments has become crucial to minimize hospital exposition. Digital technologies allow us to perform real-time monitoring of patients' clinical status. A real-time patient monitoring system through the use of a smartphone application and wearable devices was implemented at our Center during the COVID19 pandemic. Methods Since March 2020, a real time patient monitoring system was implemented at our HCT program. All consecutive adults patients transplanted between April 2020 and July 2020 were considered for the study. Vital signs and relevant clinical information were reported during 14 consecutive days after being discharged, through the online platform provided by Trilema Fundation (saludencasa.trilema.org, Fundación Trilema, Valencia, Spain). Vital signs (cardiac frequency, blood pressure, oxygen saturation) were measured with validated oxymeters (Onyx II®, Nonin Inc, Plymouth MN USA) and blood pressure monitors (iHealth Track®, Mountain View, CA USA). Temperature was measured through domiciliary thermometers. Patients were educated to measure their respiratory frequency. A checklist of clinical symptoms was filled daily. An analogue visual scale (0-10) to detect potential cases of anxiety or depressive disorders was reported daily. Scores of >6 were evaluated by a psycho-oncologist through videoconference. All the data were reported to the online platform using a smartphone app compatible with iPhone and Android systems. A direct chat between patients and physician was available through the app. Clinical information was daily supervised by an experienced HCT hematologist. Clinical interventions were arranged if significant clinical abnormalities were documented. A hematologist with experience in HCT patients revised all the patients' data daily. Programmed alarms were set in case of any of the following situations: fever >38 oC; oxygen saturation <92%; tachicardia >125/bpm, hypotension (sytolic<90 mmHg, diastolic > 60 mmHg; altered mental status; persistent emesis or diarrhea). Patient´s satisfaction questionnaires were evaluated individually after finalizing the 14-days clinical monitoring. Results During the study period, 21 adults underwent HCT and 16 were s were eligible to be recruited into the study (80% feasibility) with team effort and without additional costs. Reasons for not being enrolled were: language incompatibility (1 patient), no consent (1 patient), not compatible smartphone (3 patients). Of the 16 enrolled patients, median age was 50 (range 22-70 years), 37% were female and 94% had lymphoid diseases. Thirty-eight percent of HCTs were autologous and 62% allogeneic. Of the 16 enrolled patients, 25% were not able to adequately use the app due to inability in using smartphone applications. Of the remaining 12 patients, adherence in reporting study data (number of days reported of the planned 14 days study period) was as follows (average): temperature 89%, oxygen saturation 90%, respiratory frequency 70%, cardiac frequency 85%, blood pressure 89%, symptoms reporting 65%, emotional distress 71%. Automatic alarms were activated only 3 times: twice for the presence of clinical symptoms and once, for emotional distress. A videoconference with the psycho-oncologist was requested by one patient only. The chat service to communicate with hospital personnel was used in 4 patients. Data collected with the digital system helped the clinician to early recognize arterial hypertension (1 patient) and acute cutaneous GVHD grade 1 (1 patient). Only two patients of the whole cohort were readmitted within 14 days from discharge due to grade 4 odynophagia due to HSV1/2 reactivation. Patients´ experiences with telehealth systems are reported in table 1. Conclusion Telehealth monitoring can potentially improve patient's follow-up in terms of both physical and psychological outcomes. Technological problems still represent a barrier to a wider application of telehealth monitoring systems in the medical setting. Disclosures Mussetti: Novartis, Gilead: Honoraria, Research Funding. Sureda Balari:Incyte: Consultancy; Janssen: Consultancy, Honoraria; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; BMS: Speakers Bureau; Roche: Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Sanofi: Consultancy, Honoraria; Gilead/Kite: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau.

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Anesthesia providers' visual attention in simulated anesthesia emergencies using conventional number-based and avatar-based patient monitoring: a prospective, eye-tracking study. (Preprint)

10.2196/preprints.35642 ◽

2021 ◽

Author(s):

Arsène Ljubenovic ◽

Sadiq Said ◽

Julia Braun ◽

Bastian Grande ◽

Michaela Kolbe ◽

...

Keyword(s):

Visual Attention ◽

Eye Tracking ◽

Task Performance ◽

Situation Awareness ◽

Dwell Time ◽

Patient Monitoring ◽

Situational Awareness ◽

Patient Monitor ◽

Anesthesia Providers ◽

Significant Difference

BACKGROUND Inadequate situational awareness accounts for two-thirds of preventable complications in anesthesia. An essential tool for situational awareness in the perioperative setting is the patient monitor. However, the conventional monitor has several weaknesses. Avatar-based patient monitoring may address these shortcomings and promote situation awareness, a prerequisite for good decision making. OBJECTIVE The spatial distribution of visual attention is a fundamental process for achieving adequate situation awareness and thus a potential quantifiable surrogate for situation awareness. Moreover, measuring visual attention with a head-mounted eye-tracker may provide insights into usage and acceptance of the new avatar-based patient monitoring modality. METHODS This prospective eye-tracking study compared anesthesia providers' visual attention on conventional and avatar-based patient monitors during simulated critical anesthesia events. We defined visual attention, measured as fixation count and dwell time, as our primary outcome. We correlated visual attention with the potential confounders: performance in managing simulated critical anesthesia events (task performance), work experience, and profession. We used mixed linear models to analyze the results. RESULTS Fifty-two teams performed 156 simulations. After a manual quality check of the eye-tracking footage, we excluded 57 simulations due to technical problems and quality issues. Participants had a median of 198 (IQR 92.5 – 317.5) fixations on the patient monitor with a median dwell time of 30.2 (IQR 14.9 – 51.3) seconds. We found no significant difference in participants' visual attention when using avatar-based patient monitoring or conventional patient monitoring. However, we found that with each percentage point of better task performance, the number of fixations decreased by about 1.39 (coefficient -1.39; 95%CI: -2.44 to -0.34; P=0.02), and the dwell time diminished by 0.23 seconds (coefficient -0.23; 95%CI: -0.4 to -0.06; P=0.01). CONCLUSIONS Using eye-tracking, we found no significant difference in visual attention when anesthesia providers used avatar-based monitoring or conventional patient monitoring in simulated critical anesthesia events. However, we identified visual attention in conjunction with task performance as a surrogate for situational awareness. CLINICALTRIAL Business Management System for Ethics Committees Number Req-2020-00059

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Trajectories of Vital Signs and Risk of In-Hospital Cardiac Arrest

Frontiers in Medicine ◽

10.3389/fmed.2021.800943 ◽

2022 ◽

Vol 8 ◽

Author(s):

Chu-Lin Tsai ◽

Tsung-Chien Lu ◽

Chih-Hung Wang ◽

Cheng-Chung Fang ◽

Wen-Jone Chen ◽

...

Keyword(s):

Cardiac Arrest ◽

Oxygen Saturation ◽

Vital Sign ◽

Troponin I ◽

Medical Center ◽

Multivariable Analysis ◽

Vital Signs ◽

Reactive Protein ◽

Laboratory Markers ◽

Hospital Cardiac Arrest

Background: Little is known about the trajectories of vital signs prior to in-hospital cardiac arrest (IHCA), which could explain the heterogeneous processes preceding this event. We aimed to identify clinically relevant subphenotypes at high risk of IHCA in the emergency department (ED).Methods: This retrospective cohort study used electronic clinical warehouse data from a tertiary medical center. We retrieved data from 733,398 ED visits over a 7-year period. We selected one ED visit per person and retrieved patient demographics, triage data, vital signs (systolic blood pressure [SBP], heart rate [HR], body temperature, respiratory rate, oxygen saturation), selected laboratory markers, and IHCA status. Group-based trajectory modeling was performed.Results: There were 37,697 adult ED patients with a total of 1,507,121 data points across all vital-sign categories. Three to four trajectory groups per vital-sign category were identified, and the following five trajectory groups were associated with a higher rate of IHCA: low and fluctuating SBP, high and fluctuating HR, persistent hypothermia, recurring tachypnea, and low and fluctuating oxygen saturation. The IHCA-prone trajectory group was associated with a higher triage level and a higher mortality rate, compared to other trajectory groups. Except for the persistent hypothermia group, the other four trajectory groups were more likely to have higher levels of C-reactive protein, lactic acid, cardiac troponin I, and D-dimer. Multivariable analysis revealed that hypothermia (adjusted odds ratio [aOR], 2.20; 95% confidence interval [95%CI], 1.35–3.57) and recurring tachypnea (aOR 2.44; 95%CI, 1.24–4.79) were independently associated with IHCA.Conclusions: We identified five novel vital-sign sub-phenotypes associated with a higher likelihood of IHCA, with distinct patterns in clinical course and laboratory markers. A better understanding of the pre-IHCA vital-sign trajectories may help with the early identification of deteriorating patients.

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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.

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