P2.D064: Can Caregivers Reliably Assess their Child’s Heart Rate and Respiration Rate Using Smartphone or Smartwatch Applications?

Background: Vital signs play an important role in determining which patients need medical treatment and which are at risk of deterioration. Caregiver monitoring of heart rate (HR) and respiratory rate (RR) with smartphone or smartwatch applications (apps) may improve the quality of pediatric telephone triage or virtual visits and help determine which patients require in-person evaluation. Our objective was to compare HR and RR measured by caregivers with smartphone and smartwatch apps to simultaneous measurements by nurses in the pediatric emergency department (PED).

Methods: Patients under 18 years were prospectively recruited from a PED at an academic children’s hospital between January 5 and June 30, 2023. HR and RR were measured by caregivers and nurses simultaneously. Nurses used pulse oximeters or cardiorespiratory monitors for assessment of HR and visual assessment of chest rise for RR. Caregivers measured RR on a smartphone app and HR on both smartphone and smartwatch apps. Reproducibility was assessed using Bland-Altman (BA) analyses and summarized using Kappa agreement. We surveyed caregivers on their level of comfort with the apps before and after use.

Results: We recruited 213 patients with median (IQR) age of 7 (4 to 13) years. For measurement of RR, no bias was evident, but the limits of agreement (LOA) were wide (between –23 and +24 breaths/minute). For HR measurement by smartphone, caregivers reported consistently lower values than nurses (bias: –22 beats/minute), and LOA was wide (–32 to +75 beats/minute), but with improved performance in older children. On the other hand, HR measurement by smartwatch showed no evidence of bias and the LOA were acceptable (–5 to +5 beats/minute) and caregivers rated it most comfortable to use.

Conclusion: When compared with nurse assessed vital signs, our study showed poor performance for caregiver measured vital signs in smartphone apps in children presenting to the PED. However, the smartwatch did reliably assess HR, and caregivers rated it most highly. Next steps include testing the performance of these devices in the home setting.