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Agreement and Performance of Intermittent and Continuous Vital Signs in Critically Ill Children
Colleen M Badke1,2, L Nelson Sanchez-Pinto1,2
1Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Insights
Intermittent vital sign (VS) documentation misses critical patient data. High-frequency VS monitoring offers a slight but significant improvement in predicting cardiorespiratory dysfunction in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric critical care medicine
- Biomedical engineering
- Health informatics
Background:
- Intermittent vital sign (VS) documentation is standard in pediatric wards and intensive care units (PICUs).
- This method may miss crucial data trajectories and extreme values, especially in patients at risk of organ dysfunction.
Purpose of the Study:
- To compare agreement between intermittently charted and high-frequency (continuous) bedside monitor VS measurements.
- To evaluate the predictive performance of both VS measurement types for cardiorespiratory dysfunction.
Main Methods:
- A retrospective study analyzed 12,189 PICU encounters with over 1.5 million paired VS observations.
- Agreement was assessed by comparing high-frequency VS ranges with intermittent VS.
- XGBoost models predicted cardiorespiratory dysfunction using intermittent vs. high-frequency VS, with performance compared via AUROC curves.
Main Results:
- Agreement varied, with 21-33% of intermittent VS measurements falling outside the high-frequency range.
- Cardiorespiratory dysfunction occurred in 36.4% of encounters.
- High-frequency VS measurements showed a significantly higher, though small, predictive performance for cardiorespiratory dysfunction (AUROC 0.64 vs. 0.63, P < .001).
Conclusions:
- A significant portion (20-30%) of intermittent VS measurements fall outside the expected high-frequency bedside monitor range.
- High-frequency VS monitoring demonstrates a statistically significant, albeit weak, advantage over intermittent charting for predicting cardiorespiratory dysfunction.
Background:
Intermittent vital sign (VS) documentation is the standard of care in pediatric wards and pediatric intensive care units (PICUs). However, intermittent capture of VS values may miss important trajectories and extreme values, particularly for patients at risk of organ dysfunction.
Objective:
Determine the agreement between intermittently charted and high-frequency (continuous) bedside monitor VS measurements, as well as the performance of the 2 types of VS measurements to predict cardiorespiratory dysfunction.
Methods:
This was a single-center, retrospective study of children admitted to the PICU. We examined agreement by comparing the range of high-frequency VS measurements with the corresponding intermittently charted VS measurements. To assess the performance for predicting cardiorespiratory dysfunction, both sets of VS measurements were summarized as the worst values at an hourly level. The dataset was temporally divided into training and test sets, and XGBoost models were trained using either the intermittent or high-frequency values. The area under the receiver operating characteristic (AUROC) curve of both models was compared using the DeLong methods.
Results:
There were 12 189 PICU encounters, with over 1.5 million paired VS observations. Agreement varied based on the VS, with 21% to 33% of all intermittently charted VS measurements out of range from the high-frequency VS measurements. Cardiorespiratory dysfunction occurred in 36.4% of encounters. High-frequency VS measurements had a small but significantly higher performance at predicting cardiorespiratory dysfunction compared with intermittently charted VS measurements (AUROC, 0.64 vs 0.63; P < .001).
Conclusions:
About 20% to 30% of intermittently charted VS measurements do not fall into the expected high-frequency, bedside monitor range. High-frequency VS measurements are weakly but significantly better than intermittently charted VS measurements in predicting cardiorespiratory dysfunction.
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