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Analytical accuracy of the handheld PICO monitoring device during emergencies
  1. Walter Sylvain Renier1,
  2. Koen Erard2,
  3. Marc Sabbe3,
  4. Ives Hubloue4,
  5. Jan Y Verbakel1,5,
  6. Bert Aertgeerts1,
  7. Frank Buntinx1,6
  1. 1 Department of Public Health and Primary Care (General Practice), KU Leuven, Leuven, Belgium
  2. 2 Department of Cardiology, Sint-Jan Hospital, Brussels, Belgium
  3. 3 Department of Emergency Medicine UZB, University Hospital Brussels, Brussels, Belgium
  4. 4 Department of Emergency Medicine UZL, University Hospital Gasthuisberg, Leuven, Belgium
  5. 5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  6. 6 Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Dr Walter Sylvain Renier, Department of Public Health and Primary Care (General Practice), KU Leuven, Leuven 3000, Belgium; walter.renier{at}


Introduction General practitioners (GP) use few technical devices during emergency situations. They have to recognise which patients have a life-threatening disease in order to treat or refer them appropriately. Monitoring by a wearable device could help GPs while waiting for the emergency physician to arrive. The PICO monitor is a handheld monitoring device, capable of registering five routine parameters and small enough to be carried in the GP’s bag. We aim to determine the analytical accuracy of the PICO monitor in adults, comparing the recorded vital signs and ECGs of the PICO with those of a standard emergency department (ED) monitor.

Methods Adult (≥18 years) patients, admitted on two inpatient university EDs in Belgium, were recruited. We recorded the SpO2, heart rate (HR), respiration rate (RR), temperature (T°) and 5-lead ECGs. We analysed the correlation and agreement between the continuous and dichotomous variables of the PICO and the ED monitors.

Results We included 226 patients (84% of 268 approached), mean age 66 years, 61% were men. The Bland and Altman analysis confirmed the good accuracy, giving a nearly perfect agreement for SpO2 (difference —0.9%), for HR (−1.5 beats), for RR between the monitors (0.1 breaths), for RR between the manually counted and the PICO or the monitor (respectively 0.2 and 0.0 breaths), also confirmed by the regression analysis (Passing-Bablok). Analysis of 219 ECG records provided a near perfect agreement between the devices (kappa respectively 0.61–0.80 and 0.81–1.00) for the most important ECG abnormalities. In none of the comparisons, differences were clinically relevant.

Conclusion We were able to confirm the analytical accuracy of the PICO monitor in comparison with the ED monitors. The PICO monitor can be considered a reliable device for monitoring patients during emergencies by GPs and even in ambulances or EDs as a mobile alternative.

  • emergencies
  • general practitioner
  • emergency physician
  • monitoring
  • respiration rate

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  • Contributors WSR was the investigator and author, and submitted the study. EK was the cardiologist for protocoling the ECGs. MS was the head of the ED of UZLeuven, made the study possible in his ED and reviewed the document. IH was the head of the ED of UZBrussel, made the study possible is his ED and reviewed the document. JYV reviewed the study and the language. BA was the copromotor, responsible for the overall content and is coresponsible for the study planning. FB was the promotor, responsible for the overall content and is coresponsible for the study planning.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The ethical review board of the KU Leuven and of the Vrije Universiteit Brussel approved the study (Belg Regnr B322201629922).

  • Provenance and peer review Not commissioned; externally peer reviewed.