Abstract
Background
Continuous vital sign monitoring detects far more severe vital sign deviations (SVDs) than intermittent clinical rounds, and deviations are to some extent related to subsequent serious adverse events (SAEs). Early detection of SAEs is pivotal to allow for effective interventions but the time relationship between detection of SAEs by continuous vital sign monitoring versus clinical practice is not well-described at the general ward.
Aim
To quantify the time difference between detection of SAEs by continuous vital sign monitoring and clinical suspicion of deterioration (CSD) in major abdominal surgery patients.
Methods
Five hundred and five patients had their vital signs continuously monitored in combination with usual clinical practice consisting of National Early Warning Score assessments at least every 8'th hour, assessments during rounds, and other kinds of staff-patient interactions. The primary outcome was the time difference between the first chart note of CSD versus the first SVD, detected by continuous vital sign monitoring, in patients with a subsequent confirmed SAE during or up to 48 h after end of continuous vital sign monitoring.
Results
Out of the 505 continuously monitored patients, 142 patients had a combination of both postoperative SAE, CSD and SVD, and thus were included in the primary analysis. The median time from the first SVD to SAE was 42.8 h (interquartile range 19.8–72.1 h) compared to 13 minutes (interquartile range − 4.8 to 3.5 h) for CSD with a median difference of 48.1 h (95% confidence interval 43.0–54.8 h), p-value < .001.
Conclusion
Continuous vital sign monitoring detects signs of oncoming SAEs in the form of SVD hours before CSD, potentially allowing for earlier and more effective treatments to reduce the extent of SAEs.
Continuous vital sign monitoring detects far more severe vital sign deviations (SVDs) than intermittent clinical rounds, and deviations are to some extent related to subsequent serious adverse events (SAEs). Early detection of SAEs is pivotal to allow for effective interventions but the time relationship between detection of SAEs by continuous vital sign monitoring versus clinical practice is not well-described at the general ward.
Aim
To quantify the time difference between detection of SAEs by continuous vital sign monitoring and clinical suspicion of deterioration (CSD) in major abdominal surgery patients.
Methods
Five hundred and five patients had their vital signs continuously monitored in combination with usual clinical practice consisting of National Early Warning Score assessments at least every 8'th hour, assessments during rounds, and other kinds of staff-patient interactions. The primary outcome was the time difference between the first chart note of CSD versus the first SVD, detected by continuous vital sign monitoring, in patients with a subsequent confirmed SAE during or up to 48 h after end of continuous vital sign monitoring.
Results
Out of the 505 continuously monitored patients, 142 patients had a combination of both postoperative SAE, CSD and SVD, and thus were included in the primary analysis. The median time from the first SVD to SAE was 42.8 h (interquartile range 19.8–72.1 h) compared to 13 minutes (interquartile range − 4.8 to 3.5 h) for CSD with a median difference of 48.1 h (95% confidence interval 43.0–54.8 h), p-value < .001.
Conclusion
Continuous vital sign monitoring detects signs of oncoming SAEs in the form of SVD hours before CSD, potentially allowing for earlier and more effective treatments to reduce the extent of SAEs.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | e14541 |
| Tidsskrift | Acta Anaesthesiologica Scandinavica |
| Vol/bind | 69 |
| Udgave nummer | 1 |
| Antal sider | 9 |
| ISSN | 0001-5172 |
| DOI | |
| Status | Udgivet - 2025 |
Bibliografisk note
Funding Information:The WARD project is funded by the Innovation Fund Denmark, the Novo Nordic Foundation, the Danish Cancer Society, Copenhagen Centre for Health Technology, Radiometer, and the A.P. M\u00F8ller Foundation.
Publisher Copyright:
© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.