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. 2023 Mar 29:14:1138647.
doi: 10.3389/fphys.2023.1138647. eCollection 2023.

Developing a real-time detection tool and an early warning score using a continuous wearable multi-parameter monitor

Arik Eisenkraft  1   2 , Nir Goldstein  1 , Roei Merin  1 , Meir Fons  1 , Arik Ben Ishay  1 , Dean Nachman  2   3 , Yftach Gepner  4
Affiliations

Developing a real-time detection tool and an early warning score using a continuous wearable multi-parameter monitor

Arik Eisenkraft et al. Front Physiol. .

Abstract

Background: Currently-used tools for early recognition of clinical deterioration have high sensitivity, but with low specificity and are based on infrequent measurements. We aimed to develop a pre-symptomatic and real-time detection and warning tool for potential patients' deterioration based on multi-parameter real-time warning score (MPRT-WS). Methods: A total of more than 2 million measurements were collected, pooled, and analyzed from 521 participants, of which 361 were patients in general wards defined at high-risk for deterioration and 160 were healthy participants allocation as controls. The risk score stratification was based on cutoffs of multiple physiological parameters predefined by a panel of specialists, and included heart rate, blood oxygen saturation (SpO2), respiratory rate, cuffless systolic and diastolic blood pressure (SBP and DBP), body temperature, stroke volume (SV), cardiac output, and systemic vascular resistance (SVR), recorded every 5 min for a period of up to 72 h. The data was used to define the various risk levels of a real-time detection and warning tool, comparing it with the clinically-used National Early Warning Score (NEWS). Results: When comparing risk levels among patients using both tools, 92.6%, 6.1%, and 1.3% of the readings were defined as "Low", "Medium", and "High" risk with NEWS, and 92.9%, 6.4%, and 0.7%, respectively, with MPRT-WS (p = 0.863 between tools). Among the 39 patients that deteriorated, 30 patients received 'High' or 'Urgent' using the MPRT-WS (42.7 ± 49.1 h before they deteriorated), and only 6 received 'High' score using the NEWS. The main abnormal vitals for the MPRT-WS were SpO2, SBP, and SV for the "Urgent" risk level, DBP, SVR, and SBP for the "High" risk level, and DBP, SpO2, and SVR for the "Medium" risk level. Conclusion: As the new detection and warning tool is based on highly-frequent monitoring capabilities, it provides medical teams with timely alerts of pre-symptomatic and real-time deterioration.

Keywords: alarm fatigue; early warning score (EWS); multi-parameter monitoring; patient deterioration; pre-symptomatic detection; prevention.

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Conflict of interest statement

AE, NG, RM, MF, and AI were employed by Biobeat Technologies Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The currently-used National Early Warning Score (NEWS) and the new tool. (A) The NEWS score is comprised of systolic blood pressure, heart rate, oxygen saturation, respiratory rate, and temperature, each with a defined risk level ranging from 0 to 3. Another feature is defined as the “Red score”, which should result in an immediate check-up of the patient, though the score is not provided in real-time. (B) The new score includes 9 vital signs: systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, respiratory rate, temperature, stroke volume, cardiac output, and systemic vascular resistance, each with a defined risk level ranging from 0 to 3. (C) The new early warning score integrates the risk levels of each parameter with a time element, i.e., at least two consecutive measurements over a 10-min period. RPM–respirations per minute; BPM–beats per minute.
FIGURE 2
FIGURE 2
Analyzing data of patients using the new tool. After the definitions of the new score were in place, we tested to see if they helped with the detection of patient deterioration. When using the new tool, most of the readings were in the range of “0”and “1”scores (80%–100% in the various physiological parameters), with only a low rate of “2”and “3”scores. RPM–respirations per minute; BPM–beats per minute.
FIGURE 3
FIGURE 3
Comparing the risk score readings between the new alert tool and the currently-used NEWS system. Included are readings from the patients (n = 361).
FIGURE 4
FIGURE 4
The number of “High” and “Urgent” events detected using the new warning tool before overt clinical deterioration. 39 patients had clinical deterioration. 30 patients of them received ‘High’ or ‘Urgent’ using the MPRT-WS, and in 23 (A) patients of these 30 that initiated an alarm, the system identified it 42.7 ± 49.1 h before they deteriorated (B). 6 of the patients with clinical deterioration received ‘High’ score using the NEWS, and in 4 of them (A), the system identified it 40.5 ± 52.9 h before they deteriorated, when frequently collected using the monitoring platform (B).
FIGURE 5
FIGURE 5
Changes from normal values in the different score levels. (A) Urgent score; (B) High score; (C) Medium score. CO, cardiac output, SV, stroke volume, SpO2 blood oxygen saturation, and systolic blood pressure (SBP) increase, while the weight of diastolic blood pressure (DBP) and systemic vascular resistance (SVR) decreases when compared with “high” and “medium” risk levels; RR, respiratory rate; HR, heart rate; Temp, temperature. (A).
FIGURE 6
FIGURE 6
Two samples of admitted patients with (A) terminal cancer and (B) sepsis. In both samples, alerts are shown based on the new detection tool. CO, cardiac output; DBP, diastolic blood pressure; HR, heart rate; RR, respiratory rate; SBP, systolic blood pressure; SpO2, blood oxygen saturation; SV, stroke volume; SVR, systemic vascular resistance.
FIGURE 7
FIGURE 7
Segmentation of “High” or “Urgent” alerts in each physiological parameter in groups of patients based on the diagnosis on admission. 3,881 readings in patients with congestive heart failure (CHF, n = 24); 3,976 readings in patients with cerebrovascular accident (CVA, n = 29); 4,844 readings in patients with chronic obstructive pulmonary disease (COPD, n = 39); 5,258 readings in patients with chronic kidney disease (CKD, n = 53); 9,727 patients with arrhythmias (n = 67). The boxes in the current figure, represent the inter-quartile range (IQR, between percentile 25 and 75). The line in the middle is the median value. The whiskers are 1.5* IQR for both sides. The diamond in each subplot is the outlier.
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