Clinical relevance of routinely measured vital signs in hospitalized patients: a systematic review.

BACKGROUND

Conflicting evidence exists on the effectiveness of routinely measured vital signs on the early detection of increased probability of adverse events.

PURPOSE

To assess the clinical relevance of routinely measured vital signs in medically and surgically hospitalized patients through a systematic review.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature, and Meta-analysen van diagnostisch onderzoek (in Dutch; MEDION) were searched to January 2013.

STUDY SELECTION

Prospective studies evaluating routine vital sign measurements of hospitalized patients, in relation to mortality, septic or circulatory shock, intensive care unit admission, bleeding, reoperation, or infection.

DATA EXTRACTION

Two reviewers independently assessed potential bias and extracted data to calculate likelihood ratios (LRs) and predictive values.

DATA SYNTHESIS

Fifteen studies were performed in medical (n = 7), surgical (n = 4), or combined patient populations (n = 4; totaling 42,565 participants). Only three studies were relatively free from potential bias. For temperature, the positive LR (LR+) ranged from 0 to 9.88 (median 1.78; n = 9 studies); heart rate 0.82 to 6.79 (median 1.51; n = 5 studies); blood pressure 0.72 to 4.7 (median 2.97; n = 4 studies); oxygen saturation 0.65 to 6.35 (median 1.74; n = 2 studies); and respiratory rate 1.27 to 1.89 (n = 3 studies). Overall, three studies reported area under the Receiver Operator Characteristic (ROC) curve (AUC) data, ranging from 0.59 to 0.76. Two studies reported on combined vital signs, in which one study found an LR+ of 47.0, but in the other the AUC was not influenced.

CONCLUSIONS

Some discriminative LR+ were found, suggesting the clinical relevance of routine vital sign measurements. However, the subject is poorly studied, and many studies have methodological flaws. Further rigorous research is needed specifically intended to investigate the clinical relevance of routinely measured vital signs.

CLINICAL RELEVANCE

The results of this research are important for clinical nurses to underpin daily routine practices and clinical decision making.