Abstract
Objective: Over the last 15 years, developments in camera technology have coincided with increased availability and affordability. This has led to an increasing interest in using these technologies in healthcare settings. Image-based monitoring methods potentially allow multiple vital signs to be measured concurrently using a non-contact sensor. We have undertaken a systematic review of the current availability and performance of these monitoring methods. Approach: A multiple database search was conducted using MEDLINE, Embase, CINAHL, Cochrane Library, OpenGrey, IEEE Xplore Library and ACM Digital Library to July 2018. We included studies comparing image-based heart rate, respiratory rate, oxygen saturation and blood pressure monitoring methods against one or more validated reference device(s). Each included study was assessed using the modified GRRAS criteria for reporting bias. Main results: Of 30 279 identified studies, 161 were included in the final analysis. Twenty studies (20/161, 12%) were carried out on patients in clinical settings, while the remainder were conducted in academic settings using healthy volunteer populations. The 18–40 age group was best represented across the identified studies. One hundred and twenty studies (120/161, 75%) estimated heart rate, followed by 62 studies (62/161, 39%) estimating respiratory rate. Fewer studies focused on oxygen saturation (11/161, 7%) or blood pressure (6/161, 4%) estimation. Fifty-one heart rate studies (51/120, 43%) and 24 respiratory rate studies (24/62, 39%) used Bland–Altman analysis to report their results. Of the heart rate studies, 28 studies (28/51, 55%) showed agreement within industry standards of 5 beats per minute. Only two studies achieved this within clinical settings. Of the respiratory rate studies, 13 studies (13/24, 54%) showed agreement within industry standards of 3 breaths per minute, but only one study achieved this in a clinical setting. Statistical analysis was heterogeneous across studies with frequent inappropriate use of correlation. The majority of studies (99/161, 61%) monitored subjects for under 5 min. Three studies (3/161, 2%) monitored subjects for over 60 min, all of which were conducted in hospital settings. Significance: Heart rate and respiratory rate monitoring using video images is currently possible and performs within clinically acceptable limits under experimental conditions. Camera-derived estimates were less accurate in the proportion of studies conducted in clinical settings. We would encourage thorough reporting of the population studied, details of clinically relevant aspects of methodology, and the use of appropriate statistical methods in future studies.Systematic review registration: PROSPERO CRD42016029167Protocol: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0615-3
Highlights
Clinical decision making relies on accurate measurement or estimation of vital signs
The term vital signs typically refers to measurements including heart rate (HR), respiratory rate (RR), blood pressure (BP), arterial oxygen saturation (SpO2) and temperature
We aim to review non-contact, non-invasive image-based vital signs monitoring in both healthcare and preclinical academic settings
Summary
Clinical decision making relies on accurate measurement or estimation of vital signs. The term vital signs typically refers to measurements including heart rate (HR), respiratory rate (RR), blood pressure (BP), arterial oxygen saturation (SpO2) and temperature. Used methods of vital signs monitoring including electrocardiograph (ECG), pulse oximeter, and sphygmomanometer are widely established and are available, quick to use, and non-invasive. There are clinical areas such as critical care and operating theatres where patients may be more unstable and physiological changes can occur rapidly. In these settings, it is important that any changes from baseline are brought to attention immediately and a continuous monitor is more suitable. Invasive arterial catheters are frequently used for continuous beat-to-beat estimation of BP in patients requiring vasopressor therapy
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