Early recognition of acutely deteriorating patients in non-intensive care units: Assessment of an innovative monitoring technology
Early recognition of acutely deteriorating patients in non-intensive care units: Assessment of an innovative monitoring technology
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DOI：
10.1002/jhm.1963
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发表时间：
2012-10-01
影响因子：
2.6
通讯作者：
Shoenfeld, Yehuda
中科院分区：
文献类型：
--
作者：
Zimlichman, Eyal;Szyper-Kravitz, Martine;Shoenfeld, Yehuda
背景：持续生命体征监测有可能发现早期临床恶化。虽然通常用于重症监护病房（ICU），但适用于地板患者的准确和无创监测技术尚未可靠使用。目的：验证Earlysense连续监测系统预测临床恶化的准确性。设计：采用回顾性数据分析的非干预性研究。单位：2个学术医疗中心2个病房。病人：被诊断患有急性呼吸道疾病而住进病房的病人。干预：通过关闭警报的Earlysense监测器监测入组患者的心率（HR）和呼吸率（RR）。测量方法：对衍生队列的生命体征数据进行回顾性分析，以确定阈值和24小时趋势警报的最佳截止值。这是通过与临床事件的相关性通过图表审查确认的内部验证。结果：纳入研究的113例患者中，9例出现重大临床恶化。发现警报并不频繁（阈值警报和趋势警报分别为每患者每天2.7和0.2个警报）。对于阈值警报，预测恶化的敏感性和特异性分别为82%和67%，HR和RR分别为64%和81%。对于趋势警报，HR的敏感性和特异性分别为78%和90%，RR的敏感性和特异性分别为100%和64%。结论：Earlysense监护仪能够连续测量RR和HR，且报警频率低。目前的研究提供的数据支持该系统准确预测患者病情恶化的能力。医院医学杂志2012；(c) 2012年医院医学会
BACKGROUND: Continuous vital sign monitoring has the potential to detect early clinical deterioration. While commonly employed in the intensive care unit (ICU), accurate and noninvasive monitoring technology suitable for floor patients has yet to be used reliably. OBJECTIVE: To establish the accuracy of the Earlysense continuous monitoring system in predicting clinical deterioration. DESIGN: Noninterventional prospective study with retrospective data analysis. SETTING: Two medical wards in 2 academic medical centers. PATIENTS: Patients admitted to a medical ward with a diagnosis of an acute respiratory condition. INTERVENTION: Enrolled patients were monitored for heart rate (HR) and respiration rate (RR) by the Earlysense monitor with the alerts turned off. MEASUREMENTS: Retrospective analysis of vital sign data was performed on a derivation cohort to identify optimal cutoffs for threshold and 24-hour trend alerts. This was internally validated through correlation with clinical events recognized through chart review. RESULTS: Of 113 patients included in the study, 9 suffered major clinical deterioration. Alerts were found to be infrequent (2.7 and 0.2 alerts per patient-day for threshold and trend alert, respectively). For the threshold alerts, sensitivity and specificity in predicting deterioration was found to be 82% and 67%, respectively, for HR and 64% and 81%, respectively, for RR. For trend alerts, sensitivity and specificity were 78% and 90% for HR, and 100% and 64% for RR, respectively. CONCLUSIONS: The Earlysense monitor was able to continuously measure RR and HR, providing low alert frequency. The current study provides data supporting the ability of this system to accurately predict patient deterioration. Journal of Hospital Medicine 2012; (c) 2012 Society of Hospital Medicine