TY  - JOUR
AU  - van Goor, Harriet M R
AU  - Vernooij, Lisette M
AU  - Breteler, Martine J M
AU  - Kalkman, Cor J
AU  - Kaasjager, Karin A H
AU  - van Loon, Kim
PY  - 2022
DA  - 2022/11/23
TI  - Association of Continuously Measured Vital Signs With Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort Study
JO  - Interact J Med Res
SP  - e40289
VL  - 11
IS  - 2
KW  - continuous monitoring
KW  - vital sign monitoring
KW  - COVID-19
KW  - general ward
KW  - vital sign
KW  - monitoring
KW  - respiration
KW  - data
KW  - respiratory insufficiency
KW  - cohort study
KW  - respiratory rate
KW  - heart rate
KW  - oxygen
KW  - clinical
AB  - Background: Continuous monitoring of vital signs has the potential to assist in the recognition of deterioration of patients admitted to the general ward. However, methods to efficiently process and use continuously measured vital sign data remain unclear. Objective: The aim of this study was to explore methods to summarize continuously measured vital sign data and evaluate their association with respiratory insufficiency in COVID-19 patients at the general ward. Methods: In this retrospective cohort study, we included patients admitted to a designated COVID-19 cohort ward equipped with continuous vital sign monitoring. We collected continuously measured data of respiratory rate, heart rate, and oxygen saturation. For each patient, 7 metrics to summarize vital sign data were calculated: mean, slope, variance, occurrence of a threshold breach, number of episodes, total duration, and area above/under a threshold. These summary measures were calculated over timeframes of either 4 or 8 hours, with a pause between the last data point and the endpoint (the “lead”) of 4, 2, 1, or 0 hours, and with 3 predefined thresholds per vital sign. The association between each of the summary measures and the occurrence of respiratory insufficiency was calculated using logistic regression analysis. Results: Of the 429 patients that were monitored, 334 were included for analysis. Of these, 66 (19.8%) patients developed respiratory insufficiency. Summarized continuously measured vital sign data in timeframes close to the endpoint showed stronger associations than data measured further in the past (ie, lead 0 vs 1, 2, or 4 hours), and summarized estimates over 4 hours of data had stronger associations than estimates taken over 8 hours of data. The mean was consistently strongly associated with respiratory insufficiency for the three vital signs: in a 4-hour timeframe without a lead, the standardized odds ratio for heart rate, respiratory rate, and oxygen saturation was 2.59 (99% CI 1.74-4.04), 5.05 (99% CI 2.87-10.03), and 3.16 (99% CI 1.78-6.26), respectively. The strength of associations of summary measures varied per vital sign, timeframe, and lead. Conclusions: The mean of a vital sign showed a relatively strong association with respiratory insufficiency for the majority of vital signs and timeframes. The type of vital sign, length of the timeframe, and length of the lead influenced the strength of associations. Highly associated summary measures and their combinations could be used in a clinical prediction score or algorithm for an automatic alarm system. 
SN  - 1929-073X
UR  - https://www.i-jmr.org/2022/2/e40289
UR  - https://doi.org/10.2196/40289
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36256803
DO  - 10.2196/40289
ID  - info:doi/10.2196/40289
ER  -