Supplementary file 1_From perception to response: translational progress implementation challenges of wearable non-invasive continuous vital sign monitoring in early warning for inpatients.docx

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.</p>Conclusion<p>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.</p>