Continuous timely monitoring of core temperature with two wearable devices in pediatric patients undergoing chemotherapy for cancer - a comparison study

Abstract

Purpose: Pediatric patients with cancer often develop chemotherapy-induced fever in neutropenia (FN), requiring emergency broad-spectrum antibiotics. Continuous temperature monitoring can lead to earlier FN detection and therapy with improved outcomes. We aimed to compare the feasibility of continuous core temperature monitoring with timely data availability between two wearable devices (WDs) in pediatric oncology patients undergoing chemotherapy.

Methods: In this prospective observational two-center study, 20 patients (median age: 8 years) undergoing chemotherapy simultaneously wore two WDs (CORE®, Everion®) for 14 days. The predefined goal was core temperature recorded in sufficient quality and available within ≤ 30 min during ≥ 18/24 h for ≥ 7/14 days in more than 15 patients.

Results: More patients reached the goal with CORE® (n = 13) versus Everion® (n = 3) (difference, 50% p < 0.001). After correcting for the transmission bottleneck caused by two WDs transmitting via one gateway, these numbers increased (n = 15 versus n = 14; difference, 5%; p = 0.69). CORE® measurements corresponded better to ear temperatures (n = 528; mean bias, - 0.07 °C; mean absolute difference, 0.35 °C) than Everion® measurements (n = 532; - 1.06 °C; 1.10 °C). Acceptance rates for the WDs were 95% for CORE® and 89% for Everion®.

Conclusion: The CORE® fulfilled the predefined feasibility criterion (15 of 20 patients) after correction for transmission bottleneck, and the Everion® nearly fulfilled it. Continuous core temperature recording of good quality and with timely data availability was feasible from preschool to adolescent patients undergoing chemotherapy for cancer. These results encourage the design of randomized controlled trials on continuously monitored core temperature in pediatric patients.

Clinicaltrials: gov (NCT04914702) on June 7, 2021.

Keywords: Continuous recording; Fever; Pediatric oncology; Recording vital signs; Supportive care; Temperature measurement; Wearable device.

Fig. 1

CORE® and Everion® worn on the upper arm in a five-year-old child. Displayed are the Everion® (left) and the CORE® (right), both worn together on one armband on the right upper arm of a five-year-old child. The CORE® is secured with a small black clip, which prevents it from disattachment from the armband. Parents gave informed consent for the publication of this photography

Fig. 2

Primary outcome measure – recording of core temperature with the CORE® (A) and the Everion® (B). Green: at least sufficient quality of core temperature, arriving on the dashboard within ≤ 30 min. Blue: at least sufficient quality of core temperature, arriving on the dashboard after > 30 min. Red: poor data quality. White: no data recorded; days ok: number of days with ≥ 18 h at least sufficient data quality arriving on the dashboard within ≤ 30 min per patient; ID: patient ID

Fig. 3

Bland–Altman plot showing means (x-axis) and differences (y-axis) between discrete ear temperature measurements and corresponding recordings of the core temperature of the CORE® (green) and the Everion® (blue). Crosses indicate measurements in patient 40, wearing devices on the upper leg; circles indicate measurements in all other patients, wearing devices on the upper arm