A new trauma severity scoring system adapted to wearable monitoring: A pilot study.

Abstract

Wearable technologies represent a strong development axis for various medical applications and these devices are increasingly used in daily life as illustrated by smart watches' popularisation. Combined with new data processing methods, it constitutes a promising opportunity for telemonitoring, triage in mass casualty situations, or early diagnosis after a traffic or sport accident. An approach to processing the physiological data is to develop severity scoring systems to quantify the critical level of an individual's health status. However, the existing severity scores require a human evaluation. A first version of a severity scoring system adapted to continuous and real-time wearable monitoring is proposed in this article. The focus is made on three physiological parameters straightforwardly measurable with wrist-wearables: heart rate, respiratory rate, and SpO2, which may be enough to characterise continuously hemodynamic and respiratory status. Intermediate score functions corresponding to each physiological parameter have been established using a sigmoid model. The boundary conditions have been defined based on a survey conducted among 54 health professionals. An adapted function has also been developed to merge the three intermediate scores into a global score. The scores are associated with a triage tricolour code: green for a low-priority casualty, orange for a delayable one, red for an urgent one. Preliminary confrontation of the new severity scoring system with real data has been carried out using a database of 84 subjects admitted to the intensive care unit. Colour classification by the new scoring system was compared with independent physicians' direct evaluation as a reference. The prediction success rate values 74% over the entire database. Two examples of continuous monitoring over time are also given. The new score has turned out to be consistent, and may be easily upgraded with the integration of additional vital signs monitoring or medical information.