TY  - JOUR
AU  - Kroloff, Maxwell
AU  - Ramezani, Ramin
AU  - Wilhalme, Holly
AU  - Naeim, Arash
PY  - 2022
DA  - 2022/1/25
TI  - Remote Monitoring of Patients With Hematologic Malignancies at High Risk of Febrile Neutropenia: Exploratory Study
JO  - JMIR Form Res
SP  - e33265
VL  - 6
IS  - 1
KW  - remote monitoring
KW  - febrile neutropenia
KW  - temperature
KW  - heart rate
KW  - oxygen saturation
KW  - mobile health
KW  - mHealth
KW  - hematologic malignancies
KW  - hematology
KW  - malignancies
KW  - digital health
KW  - clinical outcomes
AB  - Background: Febrile neutropenia is one of the most common oncologic emergencies and is associated with significant, preventable morbidity and mortality. Most patients who experience a febrile neutropenia episode are hospitalized, resulting in significant economic cost. Objective: This exploratory study implemented a remote monitoring system comprising a digital infrared thermometer and a pulse oximeter with the capability to notify providers in real time of abnormalities in vital signs that could suggest early clinical deterioration and thereby improve clinical outcomes. Methods: The remote monitoring system was implemented and compared to standard-of-care vital signs monitoring in hospitalized patients with underlying hematologic malignancies complicated by a febrile neutropenia episode in order to assess the feasibility and validity of the system. Statistical analysis was performed using the intraclass correlation coefficient (ICC) to assess the consistency between the measurements taken using traditional methods and those taken with the remote monitoring system for each of the vital sign parameters (temperature, heart rate, and oxygen saturation). A linear mixed-effects model with a random subject effect was used to estimate the variance components. Bland-Altman plots were created for the parameters to further delineate the direction of any occurring bias. Results: A total of 23 patients were enrolled in the study (mean age 56, SD 23-75 years; male patients: n=11, 47.8%). ICC analysis confirmed the high repeatability and accuracy of the heart rate assessment (ICC=0.856), acting as a supplement to remote temperature assessment. While the sensitivity and specificity for capturing tachycardia above a rate of 100 bpm were excellent (88% and 97%, respectively), the sensitivity of the remote monitoring system in capturing temperatures >37.8 °C and oxygen saturation <92% was 45% and 50%, respectively. Conclusions: Overall, this novel approach using temperature, heart rate, and oxygen saturation assessments successfully provided real-time, clinically valuable feedback to providers. While temperature and oxygen saturation assessments lagged in terms of sensitivity compared to a standard in-hospital system, the heart rate assessment provided highly accurate complementary data. As a whole, the system provided additional information that can be applied to a clinically vulnerable population. By transitioning its application to high-risk patients in the outpatient setting, this system can help prevent additional use of health care services through early provider intervention and potentially improve outcomes. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2022/1/e33265
UR  - https://doi.org/10.2196/33265
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35076403
DO  - 10.2196/33265
ID  - info:doi/10.2196/33265
ER  -