{
  "abstract": "Introduction Intermittent physiological monitoring and early warning scores (EWS) are limited in their ability to detect deteriorating patients in a timely manner. Wearable physiological sensors allow continuous remote monitoring and may be more timely and accurate in the identification of those at risk, compared with manual collection. This study aims to determine if wearable physiological sensors can be used for the early detection of postoperative deterioration, while being acceptable to patients and healthcare staff.Methods and analysis This is a prospective observational cohort study that will recruit adults undergoing major surgery in Benin, India, Ghana, Guatemala, Mexico, Nigeria, Rwanda and the UK. Participants will wear wearable physiological chest and limb sensors before, during and after surgery for up to 10 days or until discharge. In this ‘shadow-mode’ study, continuous physiological observations collected using the devices will not be made available to clinical teams. No changes in participant care will result. Standard of care clinical data will be collected contemporaneously. Continuous sensor data will be used to design algorithms to predict deterioration and specific complications in this population. Usability and feasibility testing, through focus groups, interviews and questionnaires, will be undertaken with healthcare professionals and people undergoing surgery.Ethics and dissemination Our stakeholder panel are directly involved in all aspects of this study, which will be conducted in accordance with the principles of the International Conference on Harmonisation Tripartite Guideline for Good Clinical Practice (ICH GCP) in addition to the principles of the ethics committee(s)/Institutional Review Boards (IRBs) who have reviewed and approved this study. Artificial intelligence (AI) prediction models will be reported in accordance with the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis+Artificial Intelligence (TRIPOD+AI) and Developmental and Exploratory Clinical Investigations of DEcision support systems driven by Artificial Intelligence (DECIDE-AI) reporting guidelines frameworks.Trial registration number NCT06565559.",
  "authors": [
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Afra Jiwa"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Malcolm M Cameron"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Surgery, College of Medicine, University of Lagos, Lagos, Nigeria",
        "Surgery, Lagos University Teaching Hospital, Surulere, Nigeria"
      ],
      "name": "Adesoji O Ademuyiwa"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Obafemi Awolowo University, Ife, Nigeria"
      ],
      "name": "Adewale Adisa"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Hospital General San Juan de Dios, Guatemala City, Guatemala"
      ],
      "name": "Maria Lorena Aguilera Arévalo"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Michael Bahrami Hessari"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Aneel Bhangu"
    },
    {
      "affiliations": [
        "Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Paul M Brennan"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Neil Clark"
    },
    {
      "affiliations": [
        "Usher Institute, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Kathrin Cresswell"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Iwona Czerwinska"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Luciana D’Adderio"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Eilidh Gunn"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India"
      ],
      "name": "Parvez David Haque"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Theresa Ikegwuonu"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "University of Abomey-Calavi, Cotonou, Benin"
      ],
      "name": "Ismail Lawani"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Dion Morton"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Audrey Nganwa"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "University of Rwanda, Kigali, Rwanda"
      ],
      "name": "Faustin Ntirenganya"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Riinu Pius"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Hospital Español de Veracruz, Veracruz, Mexico"
      ],
      "name": "Antonio Ramos de la Medina"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India"
      ],
      "name": "Sangeetha Samuel"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Catherine A Shaw"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Department of Surgery, University of Development Studies, Tamale, Ghana"
      ],
      "name": "Stephen Tabiri"
    },
    {
      "affiliations": [
        "Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Rosie C Townsend"
    },
    {
      "affiliations": [
        "Department of Surgery, The University of Auckland, Auckland, New Zealand"
      ],
      "name": "Chris Varghese"
    },
    {
      "affiliations": [
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK",
        "Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India"
      ],
      "name": "Dhruva Ghosh"
    },
    {
      "affiliations": [
        "Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK",
        "Universities of Birmingham and Edinburgh NIHR Global Health Research Unit on Global Surgery, Birmingham, UK"
      ],
      "name": "Ewen M Harrison"
    },
    {
      "affiliations": [],
      "name": "NIHR Global Health Research Unit on Global Surgery"
    }
  ],
  "title": "Continuous physiological monitoring for the detection of postoperative deterioration: a protocol for a multistage, multicentre, international, prospective cohort study",
  "uid": "2afa6d3a-80ad-5197-ae4d-35d22edf95ae"
}