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Updated: May 12, 2025

An Application for Pairing with Wearable Devices to Monitor Personal Health Status
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Can Caregivers Reliably Assess Their Child's Heart Rate and Respiration Rate Using Smartphone or Smartwatch

Motoki Yasuda1, Jonathan Silverman1, Al M Best2

  • 1Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Children's Hospital of Richmond at VCU and Virginia Commonwealth University School of Medicine.

Pediatric Emergency Care
|May 9, 2025
PubMed
Summary

Caregivers using iPhone apps to monitor children's heart rate (HR) and respiration rate (RR) showed poor accuracy in a pediatric emergency department. However, the Apple Watch reliably measured HR, indicating potential for remote patient monitoring.

Keywords:
caregiverheart raterespiration ratesmartphone applicationsmartwatch application

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Area of Science:

  • Digital Health and mHealth
  • Pediatric Emergency Medicine
  • Biomedical Engineering

Background:

  • Remote monitoring of vital signs using consumer technology can enhance pediatric triage and virtual care.
  • Accurate caregiver-led measurement of heart rate (HR) and respiration rate (RR) is crucial for timely clinical decisions.
  • Smartphone and smartwatch applications offer potential for at-home patient monitoring.

Purpose of the Study:

  • To compare caregiver-measured HR and RR using iPhone and Apple Watch apps against simultaneous nurse measurements in a pediatric emergency department (PED).
  • To evaluate the accuracy and reliability of consumer-grade applications for vital sign monitoring in pediatric patients.

Main Methods:

  • Prospective study of 213 pediatric patients (under 18 years) in a PED.
  • Simultaneous measurement of HR and RR by caregivers using iPhone/Apple Watch apps and by nurses using standard medical devices.
  • Reproducibility assessed via Bland-Altman analyses and Kappa agreement; caregiver comfort surveyed.

Main Results:

  • iPhone app measurements for RR showed wide limits of agreement (-23 to +24 breaths/minute).
  • iPhone app HR measurements by caregivers were consistently lower than nurse measurements (bias: -22 beats/minute) with wide limits of agreement (-75 to +32 beats/minute).
  • Apple Watch HR measurements demonstrated no bias and acceptable limits of agreement (-5 to +5 beats/minute), with high caregiver ratings.

Conclusions:

  • Caregiver-measured vital signs using iPhone apps exhibited poor performance compared to nurse assessments in a PED setting.
  • The Apple Watch demonstrated reliable HR measurement capabilities, suggesting its potential utility in pediatric remote monitoring.
  • Further validation of these consumer devices is recommended in home-based settings.