Routinely Measured Vital Signs on General Hospital Wards, a Sacred Cow or Cardinal?

2.50
Hdl Handle:
http://hdl.handle.net/10755/243286
Category:
Abstract
Type:
Presentation
Title:
Routinely Measured Vital Signs on General Hospital Wards, a Sacred Cow or Cardinal?
Author(s):
Storm-Versloot, Marja N.; Vermeulen, Hester; Lucas, Cees; Verweij, Lotte; Ludikhuize, Jeroen; Legemate, Dink A.; Goslings, J. Carel
Author Details:
Storm-Versloot, Marja N., MSc, m.n.storm@amc.uva.nl; Vermeulen, Hester, RN, PhD; Lucas, Cees, PhD; Verweij, Lotte, MSc; Ludikhuize, Jeroen, MD; Legemate, Dink A. , MD, PhD; Goslings, J. Carel , MD, PhD;
Abstract:
Purpose:

As a daily routine hospital nurses perform numerous vital sign measurements. However this ‘sacred cow’ is questioned as evidence is conflicting on the clinical relevance in relation to adverse events.

Objective: To determine the clinical relevance of routinely measured vital signs (temperature, heart rate, blood pressure, oxygen saturation and respiratory rate) in relation to mortality, septic or circular shock, ICU admittance, bleeding, re-surgery or infection in ‘not at risk’ medical and surgical hospitalized patients.

Methods: For this systematic review we searched MEDLINE, EMBASE, CENTRAL, CINAHL, and MEDION to October 2011. Prospective studies evaluating the clinical relevance of vital signs in relation to adverse events were selected. Using structured forms, data and area under curve (AUC) was extracted independently by two authors from each study. If possible, 2*2 tables were constructed for each vital sign to recalculate predictive values and likelihood ratios.  

Results: Of 13.806 citations, one diagnostic accuracy study and 14 observational studies met the inclusion criteria. All were published between 1986 and 2010, with a total of 6019 participants. Eight studies concerned multiple vital sign measurements and seven only one. Due to heterogeneity, data was not pooled. Although some discriminative positive likelihood ratios were found, this was mostly when vital signs deviates strongly from normal values, e.g. respiratory rate <6 or ≥35/min, systolic blood pressure <90 mmHg, and oxygen saturation <85%. The accompanied positive predictive value was low to moderate. The highest AUC was 76% when three vital signs deviate.

Conclusion: Scarce evidence is found on the clinical relevance of routine vital sign measurement and no evidence based recommendation could be distilled from the current literature. There is a need for further prospective clinical relevance research on single or combination of routine vital sign measurement. Daily routine practices and nurses clinical decision making should be supported with evidence.

Keywords:
nursing rituals; Vital signs; clinical relevance
Repository Posting Date:
12-Sep-2012
Date of Publication:
12-Sep-2012
Conference Date:
2012
Conference Name:
23rd International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Brisbane, Australia

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleRoutinely Measured Vital Signs on General Hospital Wards, a Sacred Cow or Cardinal?en_GB
dc.contributor.authorStorm-Versloot, Marja N.en_GB
dc.contributor.authorVermeulen, Hesteren_GB
dc.contributor.authorLucas, Ceesen_GB
dc.contributor.authorVerweij, Lotteen_GB
dc.contributor.authorLudikhuize, Jeroenen_GB
dc.contributor.authorLegemate, Dink A.en_GB
dc.contributor.authorGoslings, J. Carelen_GB
dc.author.detailsStorm-Versloot, Marja N., MSc, m.n.storm@amc.uva.nl; Vermeulen, Hester, RN, PhD; Lucas, Cees, PhD; Verweij, Lotte, MSc; Ludikhuize, Jeroen, MD; Legemate, Dink A. , MD, PhD; Goslings, J. Carel , MD, PhD;en_GB
dc.identifier.urihttp://hdl.handle.net/10755/243286-
dc.description.abstract<b>Purpose: </b> <p>As a daily routine hospital nurses perform numerous vital sign measurements. However this &lsquo;sacred cow&rsquo; is questioned as evidence is conflicting on the clinical&nbsp;relevance in relation to adverse events. <p><b>Objective: </b>To determine the clinical&nbsp;relevance of routinely measured vital signs (temperature, heart rate, blood pressure, oxygen saturation and respiratory rate) in relation to mortality, septic or circular shock, ICU admittance, bleeding, re-surgery or infection in &lsquo;not at risk&rsquo; medical and surgical hospitalized patients. <p><b>Methods: </b> For this systematic review we searched MEDLINE, EMBASE, CENTRAL, CINAHL, and MEDION to October 2011. Prospective studies evaluating the clinical&nbsp;relevance of vital signs in relation to adverse events were selected. Using structured forms, data and area under curve (AUC) was extracted independently by two authors from each study. If possible, 2*2 tables were constructed for each vital sign to recalculate predictive values and likelihood ratios.<b>&nbsp;&nbsp; </b><p><b>Results: </b>Of 13.806 citations, one diagnostic accuracy study and 14 observational studies met the inclusion criteria. All were published between 1986 and 2010, with a total of 6019 participants. Eight studies concerned multiple vital sign measurements and seven only one. Due to heterogeneity, data was not pooled. Although some discriminative positive likelihood ratios were found, this was mostly when vital signs deviates strongly from normal values, e.g. respiratory rate &lt;6 or &ge;35/min, systolic blood pressure &lt;90 mmHg, and oxygen saturation &lt;85%. The accompanied positive predictive value was low to moderate. The highest AUC was 76% when three vital signs deviate. <p><b>Conclusion: </b>Scarce evidence is found on the clinical&nbsp;relevance of routine vital sign measurement and no evidence based recommendation could be distilled from the current literature. There is a need for further prospective clinical&nbsp;relevance research on single or combination of routine vital sign measurement. Daily routine practices and nurses clinical decision making should be supported with evidence.en_GB
dc.subjectnursing ritualsen_GB
dc.subjectVital signsen_GB
dc.subjectclinical relevanceen_GB
dc.date.available2012-09-12T09:20:08Z-
dc.date.issued2012-09-12-
dc.date.accessioned2012-09-12T09:20:08Z-
dc.conference.date2012en_GB
dc.conference.name23rd International Nursing Research Congressen_GB
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen_GB
dc.conference.locationBrisbane, Australiaen_GB
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