title: Early recognition of acutely deteriorating patients in non-intensive care units: assessment of an innovative monitoring technology.
abstract: BACKGROUND
  Continuous vital sign monitoring has the potential to detect early clinical deterioration. While commonly employed in the intensive care unit (ICU), accurate and noninvasive monitoring technology suitable for floor patients has yet to be used reliably.
  
  
  OBJECTIVE
  To establish the accuracy of the Earlysense continuous monitoring system in predicting clinical deterioration.
  
  
  METHODS
  Noninterventional prospective study with retrospective data analysis.
  
  
  METHODS
  Two medical wards in 2 academic medical centers.
  
  
  METHODS
  Patients admitted to a medical ward with a diagnosis of an acute respiratory condition.
  
  
  METHODS
  Enrolled patients were monitored for heart rate (HR) and respiration rate (RR) by the Earlysense monitor with the alerts turned off.
  
  
  METHODS
  Retrospective analysis of vital sign data was performed on a derivation cohort to identify optimal cutoffs for threshold and 24-hour trend alerts. This was internally validated through correlation with clinical events recognized through chart review.
  
  
  RESULTS
  Of 113 patients included in the study, 9 suffered major clinical deterioration. Alerts were found to be infrequent (2.7 and 0.2 alerts per patient-day for threshold and trend alert, respectively). For the threshold alerts, sensitivity and specificity in predicting deterioration was found to be 82% and 67%, respectively, for HR and 64% and 81%, respectively, for RR. For trend alerts, sensitivity and specificity were 78% and 90% for HR, and 100% and 64% for RR, respectively.
  
  
  CONCLUSIONS
  The Earlysense monitor was able to continuously measure RR and HR, providing low alert frequency. The current study provides data supporting the ability of this system to accurately predict patient deterioration.
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02120, USA. ezimlichman@partners.org
authors.forename: Eyal
authors.initials: E
authors.lastname: Zimlichman
authors.forename: Martine
authors.initials: M
authors.lastname: Szyper-Kravitz
authors.forename: Zvika
authors.initials: Z
authors.lastname: Shinar
authors.forename: Tal
authors.initials: T
authors.lastname: Klap
authors.forename: Shiraz
authors.initials: S
authors.lastname: Levkovich
authors.forename: Avraham
authors.initials: A
authors.lastname: Unterman
authors.forename: Ronen
authors.initials: R
authors.lastname: Rozenblum
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
authors.forename: Howard
authors.initials: H
authors.lastname: Amital
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Shoenfeld
mesh_terms: D000046:Academic Medical Centers; D000208:Acute Disease; D000368:Aged; D004059:Diffusion of Innovation; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007297:Inpatients; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011237:Predictive Value of Tests; D056152:Respiratory Rate / Q000502:physiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D055986:Vital Signs