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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
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.
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.
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