Bowles Tim, Trentino Kevin M, Lloyd Adam, Trentino Laura, Jones Glynis, Murray Kevin, Thompson Aleesha, Halpin Sarah, Waterer Grant
Community and Virtual Care Innovation, East Metropolitan Health Service, Perth, Western Australia, Australia.
Medical School, The University of Western Australia, Perth, Western Australia, Australia.
Digit Health. 2024 Oct 10;10:20552076241288826. doi: 10.1177/20552076241288826. eCollection 2024 Jan-Dec.
The timely identification of deterioration on general wards is crucial to patient care with each hour of delay independently associated with increased risk of death. The introduction of continuous monitoring of patient vital signs on general wards, currently not standard care, may improve patient outcomes. Our aim was to investigate whether patients on general wards receiving continuous vital signs monitoring have better outcomes than patients receiving usual care.
Meta-analysis of randomised controlled trials comparing non-critical care patients receiving continuous monitoring of vital signs to usual care. We searched Medline, Embase, and Web of Science, and assessed risk of bias with version 2 of the Cochrane risk-of-bias tool for randomised trials. In addition to measures related to the early detection of deterioration, we planned to present all patient outcomes reported by the clinical trials included.
We included seven trials involving 1284 participants. There were no statistically significant differences in the four outcomes pooled. Comparing continuously monitored to normal care, the pooled odds for hospital mortality, major event/complication, and HDU/ICU admission was 0.95 (95% CI 0.59-1.53, = 0.84; 660 participants, 3 studies), 0.71 (95% CI 0.38-1.31, = 0.27; 948 participants, 4 studies) and 0.82 (95% CI 0.25-2.67, = 0.74; 655 participants, 4 studies), respectively. The mean difference for length of stay was 2.12 days lower (95% CI -5.56 to 1.32, = 0.23; 1034 participants, 6 studies).
We found no significant improvements in outcomes for patients continuously monitored compared to usual care. Further research is needed to understand what modalities of continuous monitoring may influence outcomes and investigate the implications of a telepresence service and multi-parameter scoring system.
PROSPERO CRD42023458656.
及时识别普通病房患者病情恶化情况对患者护理至关重要，每延迟一小时都独立增加死亡风险。在普通病房引入目前并非标准护理的患者生命体征连续监测，可能改善患者预后。我们的目的是调查在普通病房接受生命体征连续监测的患者是否比接受常规护理的患者有更好的预后。
对比较接受生命体征连续监测的非重症护理患者与常规护理患者的随机对照试验进行荟萃分析。我们检索了Medline、Embase和科学网，并使用Cochrane随机试验偏倚风险工具第2版评估偏倚风险。除了与早期发现病情恶化相关的指标外，我们计划展示纳入的临床试验报告的所有患者预后情况。
我们纳入了7项试验，涉及1284名参与者。汇总的四项预后指标无统计学显著差异。与常规护理相比，连续监测组的医院死亡率、重大事件/并发症以及入住重症监护病房/重症加强护理病房的合并比值比分别为0.95（95%置信区间0.59 - 1.53，P = 0.84；660名参与者，3项研究）、0.71（95%置信区间0.38 - 1.31，P = 0.27；948名参与者，4项研究）和0.82（95%置信区间0.25 - 2.67，P = 0.74；655名参与者，4项研究）。住院时间的平均差值低2.12天（95%置信区间 - 5.56至1.32，P = 0.23；1034名参与者，6项研究）。
我们发现与常规护理相比，连续监测患者的预后没有显著改善。需要进一步研究以了解哪些连续监测方式可能影响预后，并调查远程医疗服务和多参数评分系统的影响。
PROSPERO CRD42023458656
