Introduction: Despite numerous quality improvement initiatives, postoperative infection remains one of the most common complications after neurosurgery. Among patients in the neuro-intensive care unit (NICU), up to 30% have confirmed infections including meningitis, pneumonia, and urinary tract infections. Infections that occur after discharge often remain undetected until they are clinically severe. Recent advances in mobile health (mHealth) technologies may allow patient body temperature to be monitored remotely and longitudinally, both in the NICU, which currently requires hourly manual measurement by nursing, and in the outpatient setting. Using a wearable, smartphone-synced temperature monitoring system, we sought to validate its accuracy and function as well as explore its possible applications to neurosurgical patients.
Methods: We enrolled neurosurgical patients admitted postoperatively to the NICU. Body temperature was recorded using a novel, commercially-available wireless thermometer unit, Fever Smart™ (Philadelphia, PA), which syncs to smartphones via Bluetooth® (Figure A). The thermometer was placed in the axilla with an adhesive pad, and temperature was continuously recorded until readings remained constant. Three readings were averaged and compared to the average of three standard oral temperature recordings documented in patients’ charts. Oral temperatures were all within 8 hours of device recordings.
Results: A total of 36 temperature recordings from 12 patients, including one with a high fever, were compared to 36 documented oral temperature readings. The device underestimated oral temperature by a median of 1.47 F (IQR: 1.08-1.98), and required an average of 10 minutes to reach a constant recording. The device synced and updated temperature data automatically, and data was accessible in real-time from a remote site (Figure B).
Conclusions: Affordable, smartphone-connected temperature monitors allow patient body temperature to be monitored remotely by a healthcare team, and may allow for early detection of infectious complications. Although FeverSmart™ underestimates body temperature, its measurements are consistent, suggesting that a simple correction factor would improve accuracy.
Patient Care: We have validated the accuracy and function of a novel temperature monitor. The device will allow continuous, longitudinal measurement of body temperature in a broad variety of patients—in neurosurgery and in many other specialties—both in the inpatient and outpatient settings. Protocols that utilize mHealth technologies to detect fever may improve efficiency of hospitals and allow for early detection of infection. In turn, early treatment of infection may ultimately lower patient morbidity and mortality, improve quality of care, and reduce healthcare costs.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of detecting postoperative infections early
2) Discuss, in small groups, the potential applications of mHealth temperature-monitoring technologies in neurosurgery patients (in the NICU, on the hospital floor, and after discharge in the outpatient setting)
3) Identify an effective follow-up protocol, utilizing mHealth devices, to detect postoperative infection
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