van der Stam Jonna A, Mestrom Eveline H J, Nienhuijs Simon W, de Hingh Ignace H J T, Boer Arjen-Kars, van Riel Natal A W, de Groot Koen T J, Verhaegh Wim, Scharnhorst Volkher, Bouwman R Arthur
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands.
Department of Anesthesiology, Intensive Care & Pain Medicine, Catharina Hospital, Eindhoven, the Netherlands.
Eur J Surg Oncol. 2023 Jan;49(1):278-284. doi: 10.1016/j.ejso.2022.08.034. Epub 2022 Sep 2.
The shift toward remote patient monitoring methods to detect clinical deterioration requires testing of wearable devices in real-life clinical settings. This study aimed to develop a remote early warning scoring (REWS) system based on continuous measurements using a wearable device, and compare its diagnostic performance for the detection of deterioration to the diagnostic performance of the conventional modified early warning score (MEWS).
The study population of this prospective, single center trial consisted of patients who underwent major abdominal cancer surgery and were monitored using routine in-hospital spotcheck measurements of the vital parameters. Heart and respiratory rates were measured continuously using a wireless accelerometer patch (HealthDot). The prediction by MEWS of deterioration toward a complication graded Clavien-Dindo of 2 or higher was compared to the REWS derived from continuous measurements by the wearable patch.
A total of 103 patients and 1909 spot-check measurements were included in the analysis. Postoperative deterioration was observed in 29 patients. For both EWS systems, the sensitivity (MEWS: 0.20 95% CI: [0.13-0.29], REWS: 0.20 95% CI: [0.13-0.29]) and specificity (MEWS: 0.96 95% CI: [0.95-0.97], REWS: 0.96 95% CI: [0.95-0.97]) were assessed.
The diagnostic value of the REWS method, based on continuous measurements of the heart and respiratory rates, is comparable to that of the MEWS in patients following major abdominal cancer surgery. The wearable patch could detect the same amount of deteriorations, without requiring manual spot check measurements.
向用于检测临床病情恶化的远程患者监测方法的转变需要在现实临床环境中对可穿戴设备进行测试。本研究旨在基于使用可穿戴设备的连续测量开发一种远程预警评分（REWS）系统，并将其对病情恶化的诊断性能与传统改良预警评分（MEWS）的诊断性能进行比较。
这项前瞻性单中心试验的研究人群包括接受腹部大手术的患者，这些患者通过常规的院内生命体征参数抽查测量进行监测。使用无线加速度计贴片（HealthDot）连续测量心率和呼吸频率。将MEWS对Clavien-Dindo分级为2级或更高的并发症恶化的预测与可穿戴贴片连续测量得出的REWS进行比较。
分析共纳入103例患者和1909次抽查测量。观察到29例患者术后病情恶化。对于这两种预警评分系统，均评估了敏感性（MEWS：0.20 95%CI：[0.13 - 0.29]，REWS：0.20 95%CI：[0.13 - 0.29]）和特异性（MEWS：0.96 95%CI：[0.95 - 0.97]，REWS：0.96 95%CI：[0.95 - 0.97]）。
基于心率和呼吸频率连续测量的REWS方法在腹部大手术后患者中的诊断价值与MEWS相当。可穿戴贴片能够检测到相同数量的病情恶化情况，而无需人工进行抽查测量。
