New sensors for the early detection of clinical deterioration on general wards and beyond - a clinician's perspective

The use of wearable sensor technology to enhance supportive care in hospitalized palliative patients (Support trial): a prospective preliminary pilot study

BACKGROUND

Continuous monitoring of vital parameters using wearable devices offers potential benefits in palliative care, such as early detection of clinical deterioration and improving symptom management. However, evidence supporting their feasibility and utility in hospitalized palliative care patients remains scarce.

METHODS

This prospective pilot study aimed to evaluate the feasibility of continuous vital sign monitoring in hospitalized palliative care patients using wrist-worn and chest-wall devices. The study was conducted from October 2023 to November 2024 and included hospitalized patients at a university hospital. Eligible participants were required to provide written informed consent. Patients were monitored for up to 30 days or until discharge or death. Data acquisition focused on the quantity and quality of recorded parameters, including heart rate, respiratory rate, and oxygen saturation, as well as advanced hemodynamic variables. Challenges in recruitment, device performance, and data reliability were assessed.

RESULTS

A total of 275 patients were screened, with 263 excluded for not meeting eligibility criteria. Of the nine patients who provided written informed consent, two withdrew consent before study interventions, leaving seven participants. Among these, one patient completed the maximum study duration, three were discharged to outpatient care, and three died during hospitalization. Wrist-worn devices yielded valid data for 61.5% of the monitored time (median: 57.6%; range: 20.1-78.3%), while chest-wall devices achieved 55.2% (median: 62.3%; range: 3.6-100%). Heart rate and respiratory rate showed excellent reliability (> 99% data availability), whereas oxygen saturation exhibited poor performance (45.1%). The interval between the last recorded device measurement and time of death ranged from 0 to 25 min. Recruitment challenges, including strict consent requirements, resulted in premature study termination, as achieving the target sample size of 25 patients was deemed unfeasible.

CONCLUSION

This pilot study demonstrates the potential of continuous monitoring technologies in palliative care, but inconsistent data availability limits the ability to recommend their routine use at this stage. Despite these challenges, the promising results highlight the need for further studies to improve device reliability and explore the broader applicability of this technology in palliative care settings.

Reliability of an all-in-one wearable sensor for continuous vital signs monitoring in high-risk patients: the NIGHTINGALE clinical validation study

Continuous vital signs monitoring with wearable systems may improve early recognition of patient deterioration on hospital wards. The objective of this study was to determine whether the wearable Checkpoint Cardio's CPC12S, can accurately measure heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP) and temperature continuously. In an observational multicenter method comparison study of 70 high-risk surgical patients admitted to high-dependency wards; HR, RR, SpO2, BP and temperature were simultaneously measured with the CPC12S system and with ICU-grade monitoring systems in four European hospitals. Outcome measures were bias and 95% limits of agreement (LoA). Clinical accuracy was assessed with Clarke Error Grid analyses for HR and RR. A total of 3,212 h of vital signs data (on average 26 h per patient) were analyzed. For HR, bias (95% LoA) of the pooled analysis was 0.0 (-3.5 to 3.4), for RR 1.5 (-3.7 to 7.5) and for SpO2 0.4 (-3.1 to 4.0). The CPC12S system overestimated BP, with a bias of 8.9 and wide LoA (-23.3 to 41.2). Temperature was underestimated with a bias of -0.6 and LoA of -1.7 to 0.6. Clarke Error Grid analyses showed that adequate treatment decisions regarding changes in HR and RR would have been made in 99.2% and 92.0% of cases respectively. The CPC12S system showed high accuracy for measurements of HR. The accuracy of RR, SpO2 were slightly overestimated and core temperature underestimated, with LoA outside the predefined clinical acceptable range. The accuracy of BP was unacceptably low.