Biomedical Signals and Systems, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
Cardiovascular and Respiratory Physiology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
J Clin Monit Comput. 2022 Apr;36(2):407-417. doi: 10.1007/s10877-021-00666-4. Epub 2021 Feb 11.
Continuous vital signs monitoring in post-surgical ward patients may support early detection of clinical deterioration, but novel alarm approaches are required to ensure timely notification of abnormalities and prevent alarm-fatigue. The current study explored the performance of classical and various adaptive threshold-based alarm strategies to warn for vital sign abnormalities observed during development of an adverse event. A classical threshold-based alarm strategy used for continuous vital signs monitoring in surgical ward patients was evaluated retrospectively. Next, (combinations of) six methods to adapt alarm thresholds to personal or situational factors were simulated in the same dataset. Alarm performance was assessed using the overall alarm rate and sensitivity to detect adverse events. Using a wireless patch-based monitoring system, 3999 h of vital signs data was obtained in 39 patients. The clinically used classical alarm system produced 0.49 alarms/patient/day, and alarms were generated for 11 out of 18 observed adverse events. Each of the tested adaptive strategies either increased sensitivity to detect adverse events or reduced overall alarm rate. Combining specific strategies improved overall performance most and resulted in earlier presentation of alarms in case of adverse events. Strategies that adapt vital sign alarm thresholds to personal or situational factors may improve early detection of adverse events or reduce alarm rates as compared to classical alarm strategies. Accordingly, further investigation of the potential of adaptive alarms for continuous vital signs monitoring in ward patients is warranted.
术后病房患者的连续生命体征监测可以支持早期发现临床恶化情况，但需要新的报警方法来确保及时通知异常情况，并防止报警疲劳。本研究探讨了经典和各种基于自适应阈值的报警策略在预测不良事件发生时生命体征异常的表现。评估了一种用于外科病房患者连续生命体征监测的经典基于阈值的报警策略。接下来，在同一数据集内模拟了（组合使用）六种适应个人或情境因素的报警阈值的方法。使用总报警率和检测不良事件的灵敏度来评估报警性能。使用无线贴片式监测系统，在 39 名患者中获得了 3999 小时的生命体征数据。临床使用的经典报警系统产生了 0.49 次/患者/天的报警，并且为 18 次观察到的不良事件中的 11 次生成了报警。测试的每种自适应策略都提高了检测不良事件的灵敏度或降低了总报警率。结合特定策略可最大程度地提高整体性能，并在发生不良事件时更早地呈现报警。与经典报警策略相比，自适应生命体征报警阈值的策略可提高不良事件的早期检测率或降低报警率。因此，有必要进一步研究自适应报警在病房患者连续生命体征监测中的潜力。
