Chunli Dong, Junxiao Yang
The evidence base is more mature for the afferent limb of monitoring and detection than for the efferent limb of clinical assessment, intervention, escalation, and outcome improvement. Wearable monitoring should be evaluated as a complex monitor-response intervention, with explicit standard care, alarm logic, response protocols, implementation support, and response fidelity.
BACKGROUND: Intermittent ward observations may miss short-lived physiological deterioration, and failures in observation, documentation, scoring, or escalation can widen this surveillance gap. Wearable, non-invasive continuous vital-sign monitoring may narrow the gap, but its translational value depends on whether continuous data are converted into timely and sustainable clinical response.
OBJECTIVE: To map evidence on wearable continuous or near-continuous vital-sign monitoring for inpatient deterioration detection, alerting, clinical response, workflow integration, and implementation.
METHODS: We conducted a PRISMA-ScR-informed scoping review. PubMed, Embase, Web of Science, and Scopus were searched from January 2010 to May 2026. Eligible reports evaluated wearable, non-invasive monitoring in non-ICU inpatient settings and reported technical, clinical, workflow, user-experience, or implementation outcomes. Findings were synthesized along a monitor-response pathway.
RESULTS: Of 6,093 database records identified, 32 studies were included. Evidence was concentrated in signal acquisition, technical feasibility, abnormality detection, and user experience. Continuous monitoring identified oxygen desaturation and abnormal respiratory-rate episodes not captured by intermittent observations, but respiratory-rate performance varied with the sensor and comparator method. Reporting of standard care, alarm configuration, bedside reassessment, escalation procedures, and response fidelity was incomplete. Observational and before-after studies reported favorable clinical outcomes in selected settings, whereas randomized and pragmatic trials were heterogeneous and several pilot or feasibility studies were not designed or powered for uncommon clinical endpoints. One preliminary prediction-modeling study was identified.
CONCLUSION: The evidence base is more mature for the afferent limb of monitoring and detection than for the efferent limb of clinical assessment, intervention, escalation, and outcome improvement. Wearable monitoring should be evaluated as a complex monitor-response intervention, with explicit standard care, alarm logic, response protocols, implementation support, and response fidelity.