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Open Access 01-12-2023 | Original Paper

Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model

Authors: Roel V. Peelen, Yassin Eddahchouri, Mats Koeneman, René Melis, Harry van Goor, Sebastian J. H. Bredie

Published in: Journal of Medical Systems | Issue 1/2023

Abstract

To evaluate a minute-by-minute monitoring algorithm against a periodic early warning score (EWS) in detecting clinical deterioration and workload. Periodic EWSs suffer from large measurement intervals, causing late detection of deterioration. This might be prevented by continuous vital sign monitoring with a real-time algorithm such as the Visensia Safety Index (VSI). This prospective comparative data modeling cohort study (NCT04189653) compares continuous algorithmic alerts against periodic EWS in continuous monitored medical and surgical inpatients. We evaluated sensitivity, frequency, number of warnings needed to evaluate (NNE) and time of initial alert till escalation of care (EOC): Rapid Response Team activation, unplanned ICU admission, emergency surgery, or death. Also, the percentage of VSI alerting minutes was compared between patients with or without EOC. In 1529 admissions continuous VSI warned for 55% of EOC (95% CI: 45-64%) versus 51% (95% CI: 41-61%) by periodic EWS. NNE for VSI was 152 alerts per detected EOC (95% CI: 114-190) compared to 21 (95% CI: 17-28). It generated 0.99 warnings per day per patient compared to 0.13. Time from detection score till escalation was 8.3 hours (IQR: 2.6-24.8) with VSI versus 5.2 (IQR: 2.7-12.3) hours with EWS (P=0.074). The percentage of warning VSI minutes was higher in patients with EOC than in stable patients (2.36% vs 0.81%, P<0.001). Although sensitivity of detection was not significantly improved continuous vital sign monitoring shows potential for earlier alerts for deterioration compared to periodic EWS. A higher percentage of alerting minutes may indicate risk for deterioration.

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Title: Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model
Authors: Roel V. Peelen
Yassin Eddahchouri
Mats Koeneman
René Melis
Harry van Goor
Sebastian J. H. Bredie
Publication date: 01-12-2023
Publisher: Springer US
Published in: Journal of Medical Systems / Issue 1/2023
Print ISSN: 0148-5598
Electronic ISSN: 1573-689X
DOI: https://doi.org/10.1007/s10916-023-01954-z

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Comparing Continuous with Periodic Vital Sign Scoring for Clinical Deterioration Using a Patient Data Model

Abstract

Keynote webinar | Spotlight on sleep in brain health

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Abstract

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