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Assessment of shivering with a smartphone application in parturients undergoing cesarean delivery under epidural anesthesia
Abstract Number: T2B-4
Abstract Type: Original Research
Shivering is a common side-effect of epidural anesthesia, causing patient distress and interfering with blood pressure (BP) measurement(1). To date, shivering intensity (SI) has been assessed subjectively. Using a smartphone application, we aim to quantify SI objectively for the first time. We hypothesize that smartphone-derived SI will correlate with anesthesiologist-reported SI.
We recruited 20 parturients requiring cesarean delivery under epidural anesthesia. We affixed an Apple iPod Touch to the upper arm contralateral to the BP cuff. The epidural was topped up according to clinician preference and application recording started. Patient and anesthesiologist SI was reported every 10 minutes, employing a 0-10 numerical rating scale (NRS) and a previously-validated 0-2 NRS(2) respectively. Recording stopped when baby was brought to the patient.
One patient was excluded due to epidural top-up that failed to produce a block and another due to maternal pyrexia. In one patient, epidural top-up resulted in bilateral T4 block to cold, but which was inadequate during surgical testing; her data were recorded during assessment and are included in the analysis.
The application acquired acceleration data in 3 dimensions at 0.1 s intervals. We transformed the data into a 'shivering intensity' measurement. Data were analyzed using Spearman's rho correlation test. For the comparison of anesthesiologist-reported SI to measured SI, rho=0.47 (p<0.001), and for the comparison of patient-reported SI to measured SI, rho=0.38 (p=0.007).
Participants reported shivering impact as 'doesn't bother me' (33%), 'annoying or distracting' (39%), or 'distressing or unbearable' (28%). Correlation with measured SI was not significant (rho=0.36, p=0.15).
We used a smartphone application to objectively measure SI for the first time. Measured SI values demonstrated stronger positive correlation with anesthesiologist-reported SI than with patient-reported SI. We contend that the correlation may have been stronger had the scale for anesthesiologist-reported SI been more sensitive (i.e. more than 3 values). We confirm the subjective nature of patient SI reporting and propose that smartphone-derived SI could be used in studies aimed at reducing shivering. Our shivering assessment application will be available to download for free from the App Store.
1. Sebbag I et al. SOAP Annual Meeting 2013 Abst S1
2. Crowley L, Buggy D. RAPM 2008: 33; 241-252