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Koenig C, Ammann RA, Schneider C, Wyss J, Roessler J, Brack E. Continuous timely monitoring of core temperature with two wearable devices in pediatric patients undergoing chemotherapy for cancer - a comparison study. Support Care Cancer 2024; 32:188. [PMID: 38400942 PMCID: PMC10894150 DOI: 10.1007/s00520-024-08366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Pediatric patients with cancer often develop chemotherapy-induced fever in neutropenia (FN), requiring emergency broad-spectrum antibiotics. Continuous temperature monitoring can lead to earlier FN detection and therapy with improved outcomes. We aimed to compare the feasibility of continuous core temperature monitoring with timely data availability between two wearable devices (WDs) in pediatric oncology patients undergoing chemotherapy. METHODS In this prospective observational two-center study, 20 patients (median age: 8 years) undergoing chemotherapy simultaneously wore two WDs (CORE®, Everion®) for 14 days. The predefined goal was core temperature recorded in sufficient quality and available within ≤ 30 min during ≥ 18/24 h for ≥ 7/14 days in more than 15 patients. RESULTS More patients reached the goal with CORE® (n = 13) versus Everion® (n = 3) (difference, 50% p < 0.001). After correcting for the transmission bottleneck caused by two WDs transmitting via one gateway, these numbers increased (n = 15 versus n = 14; difference, 5%; p = 0.69). CORE® measurements corresponded better to ear temperatures (n = 528; mean bias, - 0.07 °C; mean absolute difference, 0.35 °C) than Everion® measurements (n = 532; - 1.06 °C; 1.10 °C). Acceptance rates for the WDs were 95% for CORE® and 89% for Everion®. CONCLUSION The CORE® fulfilled the predefined feasibility criterion (15 of 20 patients) after correction for transmission bottleneck, and the Everion® nearly fulfilled it. Continuous core temperature recording of good quality and with timely data availability was feasible from preschool to adolescent patients undergoing chemotherapy for cancer. These results encourage the design of randomized controlled trials on continuously monitored core temperature in pediatric patients. TRIAL REGISTRATION CLINICALTRIALS gov (NCT04914702) on June 7, 2021.
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Affiliation(s)
- Christa Koenig
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
| | - Roland A Ammann
- , StatConsult Ammann, Burgdorf, Switzerland
- Faculty of Medicine, University of Bern, CH-3010, Bern, Switzerland
| | - Christine Schneider
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Johanna Wyss
- Department of Pediatric Oncology and Hematology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Jochen Roessler
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
| | - Eva Brack
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland
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Nessle CN, Flora C, Sandford E, Choi SW, Tewari M. High-frequency temperature monitoring at home using a wearable device: A case series of early fever detection and antibiotic administration for febrile neutropenia with bacteremia. Pediatr Blood Cancer 2022; 69:e29835. [PMID: 35735223 PMCID: PMC9329227 DOI: 10.1002/pbc.29835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/11/2022]
Abstract
We present a case series of three febrile episodes in neutropenic pediatric cancer patients who wore a Food and Drug Administration approved high-frequency temperature monitoring (HFTM) wearable device (WD) at home. The WD detected fever events when temperature monitoring by thermometer did not detect fever or was not feasible to perform. Two of the episodes were associated with bloodstream infections and the WD detected fevers 5 and 12 h prior to fevers detected by thermometer, triggering earlier medical evaluation and more prompt administration of antibiotics. These observations provide a basis for future investigation of home-based HFTM to improve infection-related outcomes in pediatric oncology.
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Affiliation(s)
| | - Christopher Flora
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan
| | - Erin Sandford
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan
| | - Sung Won Choi
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan
- Rogel Comprehensive Cancer Center, University of Michigan
| | - Muneesh Tewari
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan
- Rogel Comprehensive Cancer Center, University of Michigan
- Department of Biomedical Engineering, University of Michigan
- Center for Computational Medicine and Bioinformatics, University of Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Haemmerli M, Ammann RA, Roessler J, Koenig C, Brack E. Vital signs in pediatric oncology patients assessed by continuous recording with a wearable device, NCT04134429. Sci Data 2022; 9:89. [PMID: 35301334 PMCID: PMC8931088 DOI: 10.1038/s41597-022-01182-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/19/2022] [Indexed: 12/13/2022] Open
Abstract
Pediatric patients with cancer are at high risk for severe infections. Changes in vital signs, triggered by infections, may be detected earlier by continuous recording with a wearable device than with discrete measurements. This prospective, observational single-center feasibility study consecutively recruited pediatric patients undergoing chemotherapy for cancer. The WD Everion® was used for 14 days in each of the 20 patients on study to continuously record vital signs. Nine different vital signs and health indicators derived from them, plus six quality scores. This resulted in 274 study days (6576 hours) with 85’854 measuring points, which are a total of 772’686 measurements of vital signs and health indicators, plus 515’124 quality scores. Additionally, non-WD data like side effects, acceptability of the WD and effort for investigators were collected. In this manuscript, we present the methods of acquisition and explanations to the complete data set, which have been made publically available on open access and which can be used to study feasibility of continuous multi-parameter recording of vital signs by a WD. Measurement(s) | Vital signs continiously | Technology Type(s) | Wearable Device | Factor Type(s) | Core temperature • Galvanic skin response • Health score • Heart rate • Heart rate variability • Oxygen saturation • Skin temperature • Skin blood perfusion | Sample Characteristic - Organism | Homo sapiens |
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Affiliation(s)
- Marion Haemmerli
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland A Ammann
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Kinderaerzte KurWerk, Burgdorf, Switzerland
| | - Jochen Roessler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christa Koenig
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Brack
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Ji Y, Han D, Han L, Xie S, Pan S. The Accuracy of a Wireless Axillary Thermometer for Core Temperature Monitoring in Pediatric Patients Having Noncardiac Surgery: An Observational Study. J Perianesth Nurs 2021; 36:685-689. [PMID: 34384688 DOI: 10.1016/j.jopan.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE A wireless and wearable axillary thermometer (iThermonitor) has been validated for perioperative core temperature monitoring in adults. The purpose of this study was to evaluate its accuracy in pediatrics having non-cardiac surgery. DESIGN Prospective observational study. METHODS From January 2019 to December 2019, 70 children aged younger than 14 years undergoing surgery in a tertiary hospital were selected. Pairs of esophageal temperatures (TEso), rectal temperatures (TRec), and axillary temperatures monitored by the iThermonitor (TiTh) were collected every 5 min during surgery. Taking TEso as reference, the bias between TEso and TiTh and the proportion of bias within ±0.5°C were calculated. Bland-Altman method was used to analyze the 95% of limits of agreement (LOA) between TiTh and TEso. The same analyses were done for TRec. FINDINGS: A total of 2232 pairs of temperatures were collected. The bias (mean ± SD) between TiTh and TEso was -0.07 °C ± 0.25°C, and 95% LOA was -0.07°C ± 0.50°C. The proportion of bias within ±0.5°C accounted for 96% (95% Confidence Interval [CI], 92-98%). Higher bias and 95% LOA, and lower proportion of bias within ± 0.5°C were found between TRec and TEso than those between TiTh and TEso. CONCLUSION During pediatric non-cardiac surgery, axillary temperature derived from iThermonitor is in good agreement with esophageal temperature and can be used as an alternative to core temperature.
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Affiliation(s)
- Yingtong Ji
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Ding Han
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Lu Han
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Siyuan Xie
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Shoudong Pan
- Department of Anesthesiology, Children's Hospital affiliated to Capital Institute of Pediatrics, Beijing, China.
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Koenig C, Ammann RA, Kuehni CE, Roessler J, Brack E. Continuous recording of vital signs with a wearable device in pediatric patients undergoing chemotherapy for cancer-an operational feasibility study. Support Care Cancer 2021; 29:5283-5292. [PMID: 33655413 PMCID: PMC7925259 DOI: 10.1007/s00520-021-06099-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Pediatric patients with cancer are at high risk for severe infections. Infections can trigger changes of vital signs long before clinical symptoms arise. Continuous recording may detect such changes earlier than discrete measurements. We aimed to assess the feasibility of continuous recording of vital signs by a wearable device (WD) in pediatric patients undergoing chemotherapy for cancer. METHODS In this prospective, observational single-center study, pediatric patients under chemotherapy wore the Everion® WD for 14 days. The predefined patient-specific goal was heart rate recorded in good quality during ≥18/24 h per day, on ≥7 consecutive days. The predefined criterion to claim feasibility was ≥15/20 patients fulfilling this patient-specific goal. RESULTS Twenty patients were included (median age, 6 years; range, 2-16). Six patients aged 3-16 years fulfilled the patient-specific goal. Quality of heart rate recording was good during 3992 of 6576 (61%) hours studied and poor during 300 (5%) hours, and no data was recorded during 2284 (35%) hours. Eighteen of 20 participants indicated that this WD is acceptable to measure vital signs in children under chemotherapy. CONCLUSION The predefined feasibility criterion was not fulfilled. This was mainly due to important compliance problems and independent of the WD itself. However, continuous recording of vital signs was possible across a very wide age range in pediatric patients undergoing chemotherapy for cancer. We recommend to study feasibility in the Everion® again, plus in further WDs, applying measures to enhance compliance. TRIAL REGISTRATION ClinicalTrials.gov (NCT04134429) on October 22, 2019.
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Affiliation(s)
- Christa Koenig
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Roland A Ammann
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Kinderaerzte KurWerk, Burgdorf, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jochen Roessler
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Brack
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Liu Y, Liu C, Gao M, Wang Y, Bai Y, Xu R, Gong R. Evaluation of a wearable wireless device with artificial intelligence, iThermonitor WT705, for continuous temperature monitoring for patients in surgical wards: a prospective comparative study. BMJ Open 2020; 10:e039474. [PMID: 33208327 PMCID: PMC7677341 DOI: 10.1136/bmjopen-2020-039474] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate a new-generation, non-invasive, wireless axillary thermometer with artificial intelligence, iThermonitor (WT705, Raiing Medical, Beijing, China), and to ascertain its feasibility for perioperative continuous body temperature monitoring in surgical patients. SETTING Departments of Biliary Surgery and Operating Room and the post-anaesthesia care unit of a university teaching hospital in Chengdu, China. PARTICIPANTS A total of 526 adult surgical patients were consecutively enrolled. DESIGN This was a prospective observational study. Axillary temperatures were continuously recorded with iThermonitor throughout the whole perioperative period. The temperatures of the contralateral armpit were measured with mercury thermometers at 8:00, 12:00, 16:00 and 20:00 every day and were used as references. OUTCOME MEASURES The outcomes were the accuracy and precision of the temperatures measured with iThermonitor, the validity to detect fever and the feasibility of continuous wear. Pairs of temperatures were evaluated with Student's t-test, Pearson's correlation and repeated-measures Bland-Altman plot. RESULTS A total of 3621 pairs of body temperatures were obtained. The temperatures measured with iThermonitor agreed with those measured with the mercury thermometers overall, with a mean difference of 0.03°C±0.35°C and a moderate correlation (r=0.755, p<0.001). The 95% limits of agreement (LoA) ranged from -0.63°C to 0.73°C, with 5.11% of the differences outside the 95% LoA. The intraclass correlation coefficient was 0.753. Continuous temperature monitoring captured more fevers than intermittent observation (117/526 vs 91/526, p<0.001), detected fever up to 4.35 hours earlier, and captured a higher peak temperature (0.29°C±0.27°C, 95% CI: 0.26-0.31). All subjects felt that wearing iThermonitor was more or less comfortable and did not affect their daily activities. CONCLUSIONS iThermonitor is promising for continuous remote temperature monitoring in surgical patients. However, further developments are still needed to improve the precision of this device, especially for temperature detection in underweight patients and those with lower body temperature. TRIAL REGISTRATION NUMBER ChiCTR1900024549; Results (registered on 5 July 2019).
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Affiliation(s)
- Yuwei Liu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, P.R.China
| | - Changqing Liu
- Operating Room of Anesthesia Surgery Center, West China Hospital of Sichuan University, Chengdu, P.R.China
| | - Min Gao
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yangjing Bai
- Department of Cardiac and Macrovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ruihua Xu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Renrong Gong
- West China School of Nursing, Sichuan University, Chengdu, P.R.China
- Department of Surgery, West China Hospital of Sichuan University, Chengdu, P.R.China
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