Should an order to "monitor long-term vital signs," including mortality outcomes, be as routine as an order for a laboratory test in patients with rheumatic diseases?
Vital signs alert a health professional to problems which may threaten patient well-being and survival. Clinicians are highly familiar with vital signs for acute disease such as blood pressure, pulse, temperature, but unfamiliar with vital signs for chronic disease, such as physical function, pain, global status, exercise frequency and smoking. Long-term vital signs should be collected at each visit and stored in a computer database, ideally in a flow sheet format, as the memory of clinicians and patients is not reliable over long periods. The structure of the database should be identical from one site to another, so that data may be pooled to analyze large series of patients, particularly those with rare diseases, such as systemic sclerosis, polymyositis, and vasculitis. Of course, appropriate additional information beyond simple "long-term vital signs" from a physical examination, radiograph and laboratory are needed for further accurate assessment of prognosis and outcomes, in both acute and chronic diseases, and optimal information will emerge from specialized research centers. A common long-term vital signs database would be a major advance from current descriptive, non-quantitative monitoring of patients with rheumatic diseases, and would allow any rheumatologist to contribute to improved knowledge and mortality outcomes of rheumatic diseases.
Pincus
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T
New York University School of Medicine, New York, USA. tedpincus@gmail.com
Sokka
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T
D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data; D006801:Humans; D010347:Patient Care Planning; D010808:Physical Examination; D012042:Registries; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000503:physiopathology; D012720:Severity of Illness Index