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Published on: February 8, 2019
Wireless monitoring and real-time adaptive predictive indicator of deterioration
Heather P Duncan1, Balazs Fule2, Iain Rice3
1Birmingham Children's Hospital, Steelhouse Lane, B4 6NH, UK. Heather.duncan5@nhs.net.
Insights
Continuous wireless monitoring in children is feasible, with the Real-time Adaptive Predictive Indicator of Deterioration (RAPID) index detecting clinical deterioration earlier than the traditional paediatric early warning (PEW) score.
Area of Science:
- Pediatric critical care
- Biomedical engineering
- Health informatics
Background:
- Hospitalized children require early detection of clinical deterioration.
- Traditional early warning scores may have limitations in timely detection.
- Continuous physiological monitoring offers potential for improved surveillance.
Purpose of the Study:
- To assess the feasibility of wireless continuous physiological data collection in children.
- To compare the performance of a novel machine learning approach (RAPID) against a standard paediatric early warning (PEW) score.
- To identify children experiencing significant clinical deterioration using advanced monitoring.
Main Methods:
- Utilized Lifetouch and WristOx2 wireless sensors for continuous ECG and pulse oximetry data.
- Collected 7,073,486 minutes of data across 982 pediatric patients.
- Compared the Real-time Adaptive Predictive Indicator of Deterioration (RAPID) index with the bedside paediatric early warning (PEW) score.
Main Results:
- Achieved 93% intended monitoring time for Lifetouch and 55% for WristOx2; valid data capture was 63% and 50% respectively.
- The RAPID index detected significant deterioration in 77% to 97% of cases, earlier than the PEW score.
- RAPID demonstrated high sensitivity and negative predictive value, but low specificity and positive predictive value.
Conclusions:
- Wireless physiological data collection is feasible for clinical use in pediatric monitoring.
- The RAPID index shows promise for earlier detection of deterioration compared to PEW scores.
- Integrating RAPID with PEW systems may help avert critical events in hospitalized children.
Abstract:
To assist in the early warning of deterioration in hospitalised children we studied the feasibility of collecting continuous wireless physiological data using Lifetouch (ECG-derived heart and respiratory rate) and WristOx2 (pulse-oximetry and derived pulse rate) sensors. We compared our bedside paediatric early warning (PEW) score and a machine learning automated approach: a Real-time Adaptive Predictive Indicator of Deterioration (RAPID) to identify children experiencing significant clinical deterioration. 982 patients contributed 7,073,486 min during 1,263 monitoring sessions. The proportion of intended monitoring time was 93% for Lifetouch and 55% for WristOx2. Valid clinical data was 63% of intended monitoring time for Lifetouch and 50% WristOx2. 29 patients experienced 36 clinically significant deteriorations. The RAPID Index detected significant deterioration more frequently (77% to 97%) and earlier than the PEW score ≥ 9/26. High sensitivity and negative predictive value for the RAPID Index was associated with low specificity and low positive predictive value. We conclude that it is feasible to collect clinically valid physiological data wirelessly for 50% of intended monitoring time. The RAPID Index identified more deterioration, before the PEW score, but has a low specificity. By using the RAPID Index with a PEW system some life-threatening events may be averted.
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