Prediction of deterioration from COVID-19 in patients in skilled nursing facilities using wearable and contact-free devices: a feasibility study
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- Evaluated articles (Rapid Reviews Infectious Diseases)
Abstract
Background and Rationale
Approximately 35% of all COVID-19 deaths occurred in Skilled Nursing Facilities (SNFs). In a healthy general population, wearables have shown promise in providing early alerts for actionable interventions during the pandemic. We tested this promise in a cohort of SNFs patients diagnosed with COVID-19 and admitted for post-acute care under quarantine. We tested if 1) deployment of wearables and contact-free biosensors is feasible in the setting of SNFs and 2) they can provide early and actionable insights into deterioration.
Methods
This prospective clinical trial has been IRB-approved ( NCT04548895 ). We deployed two commercially available devices detecting continuously every 2-3 minutes heart rate (HR), respiratory rate (RR) and uniquely providing the following biometrics: 1) the wrist-worn bracelet by Biostrap yielded continuous oxygen saturation (O2Sat), 2) the under-mattress ballistocardiography sensor by Emfit tracked in-bed activity, tossing, and sleep disturbances. Patients also underwent routine monitoring by staff every 2-4 h. For death outcomes, cases are reported due to the small sample size. For palliative care versus at-home discharges, we report mean±SD at p<0.05.
Results
From 12/2020 - 03/2021, we approached 26 PCR-confirmed SarsCoV2-positive patients at two SNFs: 5 declined, 21 were enrolled into monitoring by both sensors (female=13, male=8; age 77.2±9.1). We recorded outcomes as discharged to home (8, 38%), palliative care (9, 43%) or death (4, 19%). The O2Sat threshold of 91% alerted for intervention. Biostrap captured hypoxic events below 91% nine times as often as the routine intermittent pulse oximetry. In the patient deceased, two weeks prior we observed a wide range of O2Sat values (65-95%) captured by the Biostrap device and not noticeable with the routine vital sign spot checks. In this patient, the Emfit sensor yielded a markedly reduced RR (7/min) in contrast to 18/min from two routine spot checks performed in the same period of observation as well as compared to the seven patients discharged home over a total of 86 days of monitoring (RR 19± 4). Among the patients discharged to palliative care, a total of 76 days were monitored, HR did not differ compared to the patients discharged home (68±8 vs 70±7 bpm). However, we observed a statistically significant reduction of RR at 16±4/min as well as the variances in RR (10±6 vs 19±4/min vs16±13) and activity of palliative care patients vs. patients discharged home.
Conclusion/Discussion
We demonstrate that wearables and under-mattress sensors can be integrated successfully into the SNF workflows and are well tolerated by the patients. Moreover, specific early changes of oxygen saturation fluctuations and other biometrics herald deterioration from COVID-19 two weeks in advance and evaded detection without the devices. Wearable devices and under-mattress sensors in SNFs hold significant potential for early disease detection.
Article activity feed
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Panayiotis Kouis
Review 2: "Prediction of deterioration from COVID-19 in patients in skilled nursing facilities using wearable and contact-free devices: a feasibility study"
This preprint aims to use wearable devices to predict deterioration from COVID-19 in skilled nursing facility patients. Reviewers suggested improvements in determining statistical significance, clarifying the data collection period, and discussing viral transmission implications.
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Barbara Mayer
Review 1: "Prediction of deterioration from COVID-19 in patients in skilled nursing facilities using wearable and contact-free devices: a feasibility study"
This preprint aims to use wearable devices to predict deterioration from COVID-19 in skilled nursing facility patients. Reviewers suggested improvements in determining statistical significance, clarifying the data collection period, and discussing viral transmission implications.
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Strength of evidence
Reviewers: Barbara Mayer (Stanford) | 📗📗📗📗◻️
Panayiotis Kouis (University of Cyprus) | 📒📒📒◻️◻️ -
SciScore for 10.1101/2022.04.06.22273202: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Interventions: Biometric monitors – wearable and under-the-mattress: LTCF residents in settings with anticipated high COVID-19 incidence, who agreed to participate in the study and completed the informed consent process were each given a bracelet-like wearable and/or an under-the-mattress monitor. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The study was conducted in collaboration with Biostrap providing its wristband wearable and Emfit providing the under-mattress sensor. Biostrapsuggested: NoneResults from OddPub: We did not detect open data. We also …
SciScore for 10.1101/2022.04.06.22273202: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Interventions: Biometric monitors – wearable and under-the-mattress: LTCF residents in settings with anticipated high COVID-19 incidence, who agreed to participate in the study and completed the informed consent process were each given a bracelet-like wearable and/or an under-the-mattress monitor. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The study was conducted in collaboration with Biostrap providing its wristband wearable and Emfit providing the under-mattress sensor. Biostrapsuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04548895 Completed Non-invasive Biometric Monitoring in Nursing Homes to Fight … Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- No funding statement was detected.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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