Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Emergency Department Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
iDoc - Institut für Telemedizin und Gesundheitskommunikation GmbH & Co. KG, Berlin, Germany.
BMC Psychiatry. 2020 Apr 15;20(1):165. doi: 10.1186/s12888-020-02573-5.
Agitation is common in geriatric patients with cognitive impairment, e.g. in persons with dementia (PWD), who are admitted to an emergency department (ED). It might be a first sign of upcoming delirium and is associated with a higher risk of an unfavorable clinical course. Hence, monitoring of vital signs and enhanced movement as indicators of upcoming agitation is essential in these patients during their stay in the ED. Since PWD rarely tolerate fixed monitoring devices, a novel developed non-contact monitoring system (NCMSys) might represent an appropriate alternative. Aim of this feasibility study was to test the validity of a NCMSys and of the tent-like "Charité Dome" (ChD), aimed to shelter PWD from the busy ED environment. Furthermore, effects of the ChD on wellbeing and agitation of PWD were investigated.
Both devices were attached to patient's bed. Tests on technical validity and safety issues of NCMSys and ChD were performed at the iDoc institute with six healthy volunteers. A feasibility study evaluating the reliability of the NCMSys with and without the ChD was performed in the real-life setting of an ED and on a geriatric-gerontopsychiatric ward. 19 patients were included, ten males and nine females; mean age: 77.4 (55-93) years of which 14 were PWD. PWD inclusion criteria were age ≥ 55 years, a dementia diagnosis and a written consent (by patients or by a custodian). Exclusion criteria were acute life-threatening situations and a missing consent.
Measurements of heart rate, changes in movement and sound emissions by the NCMSys were valid, whereas patient movements affected respiratory rate measurements. The ChD did not impact patients' vital signs or movements in our study setting. However, 53% of the PWD (7/13) and most of the patients without dementia (4/5) benefited from its use regarding their agitation and overall wellbeing.
The results of this feasibility study encourage a future controlled clinical trial in geriatric ED patients, including PWD, to further evaluate if our concept of non-contact measurement of vital signs and movement combined with the "Charité Dome" helps to prevent upcoming agitation in this vulnerable patient group in the ED.
ICTRP: "Charité-Dome-Study - DRKS00014737" (retrospectively registered).
认知障碍的老年患者（例如痴呆患者）在急诊科（ED）中常出现激越。这可能是即将发生谵妄的首个迹象，与不良临床病程的风险增加相关。因此，在 ED 中这些患者应密切监测生命体征和增强活动，作为即将发生激越的指标。由于痴呆患者很少能耐受固定监测设备，因此开发的新型非接触式监测系统（NCMSys）可能是一种合适的替代方法。本可行性研究的目的是测试 NCMSys 和帐篷式“Charité Dome”（ChD）的有效性，旨在将痴呆患者与 ED 嘈杂的环境隔离开来。此外，还研究了 ChD 对痴呆患者的舒适度和激越的影响。
将两个设备都连接到患者的床上。在 iDoc 研究所使用六名健康志愿者进行了 NCMSys 和 ChD 的技术有效性和安全性测试。在 ED 的真实环境中和老年精神病病房中进行了一项可行性研究，评估了有无 ChD 的 NCMSys 的可靠性。共纳入 19 名患者，男性 10 名，女性 9 名；平均年龄：77.4（55-93）岁，其中 14 名患者患有痴呆。痴呆患者的纳入标准为年龄≥55 岁、痴呆诊断和书面同意（由患者或监护人签署）。排除标准为有生命危险的急性情况和未同意。
NCMSys 的心率、运动变化和声音测量是有效的，但是患者的运动影响了呼吸频率的测量。在我们的研究环境中，ChD 对患者的生命体征或运动没有影响。然而，53%的痴呆患者（7/13）和大多数非痴呆患者（4/5）从使用 ChD 中受益，在舒适度和整体舒适度方面有所改善。
这项可行性研究的结果鼓励在老年 ED 患者中进行未来的对照临床试验，包括痴呆患者，以进一步评估非接触式生命体征和运动测量与“Charité Dome”相结合的概念是否有助于预防 ED 中这一脆弱患者群体的激越。
ICTRP：“Charité-Dome-Study - DRKS00014737”（回顾性注册）。
