Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Shirley Ryan AbilityLab, Chicago, IL, United States; Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Int J Med Inform. 2024 Dec;192:105655. doi: 10.1016/j.ijmedinf.2024.105655. Epub 2024 Oct 16.
Resting heart rate (RHR) is a sensitive indicator of an individual's physiologic condition. However, its use in clinical practice has been limited due to the wide variation in baseline RHR based on multiple factors, including age, sex, cardiovascular fitness, and comorbidities. The study aims to develop a novel, clinically meaningful metric that is applicable across these conditions, based on day-by-day changes in RHR-the difference in autocorrelation of daily RHR (ACΔ-RHR). We present ACΔ-RHR in the context of monitoring post-discharge recovery for pediatric appendectomy patients.
Children 3-17 years old who underwent laparoscopic appendectomy for complicated appendicitis from 2019 to 2022 at a tertiary children's hospital wore a Fitbit for twenty-one postoperative days (POD). Patients without complications were included to describe normative recovery. Using RHR on POD 1-3 as the baseline, autocorrelation of daily RHR was calculated (fixed lag = 1) for POD 3-21. Then, daily ACΔ-RHR was determined by subtracting autocorrelation values between the current and previous day. Means and standard deviations were calculated for daily RHR to estimate on which POD ACΔ-RHR stabilized at 0, representing general RHR stability and recovery from surgery for all patients. Subgroup analyses were performed by age (3-10 years old vs 11-17 years old) and sex.
Thirty-one patients were included (58.1 % 3-10 years old, 41.9 % female, 67.7 % Hispanic). Whereas the mean daily RHR did not demonstrate clear trends, the mean ACΔ-RHR for the cohort first reached 0 on POD 12 and stabilized on POD 14 (95 % confidence interval: POD [11,17]). Subgroup analysis showed that ACΔ-RHR stabilized on POD 9 for age of 3-10 years, POD 12 for age of 11-17 years, POD 12 for females and POD 10 for males.
The ACΔ-RHR is a promising clinical metric that could enhance post-surgical patient monitoring, such as for children following laparoscopic appendectomy for complicated appendicitis.
静息心率（RHR）是个体生理状况的敏感指标。然而，由于 RHR 的基线因年龄、性别、心血管健康状况和合并症等多种因素而存在广泛差异，其在临床实践中的应用受到限制。本研究旨在基于 RHR 的日变化（每日 RHR 的自相关差异，ACΔ-RHR），开发一种适用于这些情况的新的、有临床意义的指标。我们在监测小儿阑尾切除术后出院后恢复的背景下介绍 ACΔ-RHR。
2019 年至 2022 年，一家三级儿童医院对患有复杂性阑尾炎的 3-17 岁儿童进行腹腔镜阑尾切除术后，让他们佩戴 Fitbit 二十一天。纳入无并发症的患者以描述正常恢复情况。使用 POD1-3 的 RHR 作为基线，计算 POD3-21 的每日 RHR 自相关（固定滞后=1）。然后，通过减去当前和前一天之间的自相关值来确定每日 ACΔ-RHR。计算每日 RHR 的平均值和标准差，以确定在哪个 POD 上 ACΔ-RHR 稳定在 0，这代表所有患者的一般 RHR 稳定性和手术恢复。通过年龄（3-10 岁与 11-17 岁）和性别进行亚组分析。
纳入 31 名患者（58.1%为 3-10 岁，41.9%为女性，67.7%为西班牙裔）。虽然平均每日 RHR 没有明显趋势，但该队列的平均 ACΔ-RHR 首先在 POD12 达到 0，并在 POD14 稳定（95%置信区间：POD[11,17]）。亚组分析显示，年龄为 3-10 岁的患者 ACΔ-RHR 在 POD9 稳定，年龄为 11-17 岁的患者 ACΔ-RHR 在 POD12 稳定，女性在 POD12 稳定，男性在 POD10 稳定。
ACΔ-RHR 是一种很有前途的临床指标，可增强术后患者监测，例如对复杂性阑尾炎行腹腔镜阑尾切除术后的儿童。
