New research from the Technical University of Munich has found remote monitoring of COVID-19 patients can effectively identify the earliest stages of deterioration and admit them to hospital for necessary treatment. The system uses an in-ear sensor to measure and transmit data in near real-time to doctors who then evaluate when patients need hospital admission.
As many places in the world have experienced, hospitals can quickly fill up with COVID-19 patients when waves of infections spread through a local community. As well as helping those patients most in need of acute treatment, doctors try to admit patients at a high-risk of deterioration so they can be treated effectively at the earliest opportunity. But sometimes it is not easy to identify those patients quickly, and many sick people have been sent home only to return days later in dire straits.
This new research trialled a system whereby newly diagnosed COVID-19 patients flagged at high risk of severe disease were sent home with a device designed to monitor a number of vital signs. The health data captured by the device was monitored remotely by a team of health care workers and patients were called in to hospital when vital signs indicated a deterioration in their condition.
The study utilized a commercially available in-ear sensor produced by a company called cosinuss. The sensor resembles a small hearing aid and contains a photoplethysmography (PPG) sensor element, a contact temperature sensor and an accelerometer. It can measure heart rate, core body temperature, blood oxygen saturation, and respiratory rate.
The device connects to a smartphone via Bluetooth and takes measurements of vital signs every 15 minutes. The data is then transmitted to a telemedicine center allowing for constant oversight from a team of doctors.
Around 150 patients were recruited for the study. The median age of the cohort was 60 and each participant had at least one pre-existing condition including diabetes, obesity, or cardiovascular disease.
Over the course of the study 20 patients were flagged for deteriorating vital signs and admitted into hospital. Seven of those patients ended up in intensive care, and one sadly passed away.
Unsurprisingly, blood oxygen levels were a key indicator of deterioration. The average measurement in patients before hospitalization was 88 percent, whereas the average measurement in patients not hospitalized was 96 percent.
"To our knowledge, this is the first study worldwide to continuously monitor patients in home isolation remotely and to prompt immediate hospitalization in the event of critical health deterioration," explains Georg Schmidt, a researcher working on the study.
The majority of those participating in the study said the monitoring system made them feel safer and improved their subjective well-being. A striking 90 percent of those patients ultimately hospitalized said they would not have come to hospital at the time they were contacted to be admitted. This suggests monitoring vital signs remotely can catch disease deterioration before someone is conscious of their declining condition.
As the study obviously had no conventional care group to act as a control, it is impossible to determine whether this kind of remote monitoring leads to better outcomes than the alternative. The researchers do speculate that the monitoring often led to calling patients into hospital before they would have voluntarily chosen to come, meaning treatment could be administered at earlier stages, likely resulting in better outcomes and ultimately, shorter hospital stays.
“We assume that in the event of a pandemic, such remote monitoring will help to relieve the burden on general practitioners and medical officers,” the researchers propose. “Patients can be well cared for by telemedicine without the need for direct contact with a doctor or a nurse. This means that no unnecessary resources are bound and, additionally, the risk of infection for medical and nursing staff can be reduced. At the same time, the patient’s chances of survival are likely to be increased, as their clinical course is continuously monitored.”
The new study was published in the journal PLOS One.
Source: TUM
