More studies needed to prove utility of wearable monitoring systems in detecting deterioration

There is not enough evidence to support the implementation of wearable monitoring systems (WMS) for the early detection of patient deterioration or for improvement of associated outcomes, according to a recent systematic review.

“Our results are limited by the small number of studies, limited sample sizes, and overall moderate risk of bias, failing to provide a generalizable answer to our research question,” the researchers said. “This review also suggests a trend towards WMS decreasing in-hospital mortality and length of stay, but again without strong statistical significance supporting these findings.”

A systematic search of the online databases of Medline, Embase, CINAHL, the Cochrane Database of Systematic Reviews, CENTRAL, and Health Technology Assessment, as well as of grey literature, yielded 10 studies eligible for inclusion. Only those that directly compared WMS with standard care for detecting deterioration-related outcomes—such as unplanned intensive care admissions and complication rates—were included.

Notably, the included studies showed high heterogeneity across different domains. For instance, several different WMS devices were used and in different configurations; some were used alone or in combination with other wearables. Study design varied, too, including randomized controlled trials (RCT), cluster RCTs, and before-and-after observational studies [Crit Care 2021;25:351].

The overall methodological quality of the included studies was moderate, though researchers flagged potential bias. Two RCTs were at low risk of bias, while three, including one cluster RCT, raised some concerns. For all before-and-after studies, the risk of bias was moderate.

Seven studies were eligible for meta-analysis for the detection of deterioration. Pooled analyses revealed that WMS could reduce intensive care transfers (risk ratio [RR], 0.87, 95 percent confidence interval [CI], 0.66–1.15; p=0.32), rapid response time or cardiac arrest calls (RR, 0.84, 95 percent CI, 0.69–1.01; p=0.07), and all clinical complications (RR, 0.77, 95 percent CI, 0.44–1.32; p=0.17), but none to a statistically significant degree.

Similarly, WMS showed signals of effectiveness in reducing mortality risk (RR, 0.48, 95 percent CI, 0.18–1.29; p=0.15) and hospital length of stay (mean difference, –0.09, 95 percent CI, –0.46 to 0.28; p=0.63), but likewise failed to reach significance.

Subsequent exploratory analyses focused on alerting systems and suggested that “’less is more,’” the researchers said. “Studies seemed to focus on reducing false alarms and, consequently, increase the number of actionable alarms. Future implementation research should consider this, as well as the time required for the alarm system optimization before WMS deployment.”

“The results of this systematic review highlighted the need for more bigger and better studies to support WMS implementation and test its impact on early deterioration detection and clinical outcomes,” they added.