{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T17:39:51Z","timestamp":1783791591818,"version":"3.55.0"},"reference-count":20,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","license":[{"start":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T00:00:00Z","timestamp":1704240000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Tetanus is a disease associated with significant morbidity and mortality. Heart rate variability (HRV) is an objective clinical marker with potential value in tetanus. This study aimed to investigate the use of wearable devices to collect HRV data and the relationship between HRV and tetanus severity. Data were collected from 110 patients admitted to the intensive care unit in a tertiary hospital in Vietnam. HRV indices were calculated from 5-minute segments of 24-hour electrocardiogram recordings collected using wearable devices. HRV was found to be inversely related to disease severity. The standard deviation of NN intervals and interquartile range of RR intervals (IRRR) were significantly associated with the presence of muscle spasms; low frequency (LF) and high frequency (HF) indices were significantly associated with severe respiratory compromise; and the standard deviation of differences between adjacent NN intervals, root mean square of successive differences between normal heartbeats, LF to HF ratio, total frequency power, and IRRR, were significantly associated with autonomic nervous system dysfunction. The findings support the potential value of HRV as a marker for tetanus severity, identifying specific indices associated with clinical severity thresholds. Data were recorded using wearable devices, demonstrating this approach in resource-limited settings where most tetanus occurs.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0531","type":"journal-article","created":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T16:27:28Z","timestamp":1700497648000},"page":"165-169","source":"Crossref","is-referenced-by-count":3,"title":["Heart Rate Variability Measured from Wearable Devices as a Marker of Disease Severity in Tetanus"],"prefix":"10.4269","volume":"110","author":[{"given":"Ho Bich","family":"Hai","sequence":"first","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan W. S.","family":"Cattrall","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"},{"name":"Department of Psychiatry, University of Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Van","family":"Hao","sequence":"additional","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"},{"name":"University Medicine and Pharmacy, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoang Minh Tu","family":"Van","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duong Bich","family":"Thuy","sequence":"additional","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phung Tran Huy","family":"Nhat","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phan Nguyen Quoc","family":"Khanh","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha Thi Hai","family":"Duong","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"},{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"},{"name":"Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tran Duc","family":"Duong","sequence":"additional","affiliation":[{"name":"Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Lu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le Thanh","family":"Phuong","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heloise","family":"Greeff","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Zhu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lam Minh","family":"Yen","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Clifton","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, University of Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Louise","family":"Thwaites","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam;"},{"name":"Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"1204","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020"},{"key":"b2","series-title":"Lancet","first-page":"1657","article-title":"Tetanus","volume":"393","author":"Yen","year":"2019"},{"key":"b3","series-title":"Trop Med Health","first-page":"20","article-title":"Urinary catecholamine excretion, cardiovascular variability, and outcomes in tetanus","volume":"51","author":"Du","year":"2023"},{"key":"b4","series-title":"Front Psychol","first-page":"1040","article-title":"A healthy heart is not a metronome: an integrative review of the heart\u2019s anatomy and heart rate variability","volume":"5","author":"Shaffer","year":"2014"},{"key":"b5","series-title":"BMJ Innov","first-page":"s7","article-title":"Vital sign monitoring using wearable devices in a Vietnamese intensive care unit","volume":"7","author":"Van","year":"2021"},{"key":"b6","series-title":"Am J Trop Med Hyg","first-page":"403","article-title":"Heart rate variability as an indicator of autonomic nervous system disturbance in tetanus","volume":"102","author":"Duong","year":"2019"},{"key":"b7","series-title":"Healthc Technol Lett","first-page":"45","article-title":"Severity detection tool for patients with infectious disease","volume":"7","author":"Tadesse","year":"2020"},{"key":"b8","series-title":"IEEE Trans Biomed Eng","first-page":"1340","article-title":"Improving classification of tetanus severity for patients in low-middle income countries wearing ECG sensors by using a CNN-transformer network","volume":"70","author":"Lu","year":"2023"},{"key":"b9","author":"Yen","year":"2018"},{"key":"b10","series-title":"Wellcome Open Res","first-page":"107","article-title":"The management of tetanus in adults in an intensive care unit in southern Vietnam","volume":"6","author":"Hao","year":"2021"},{"key":"b11","series-title":"Anaesthesia","first-page":"355","article-title":"Urinary catecholamine excretion in tetanus","volume":"61","author":"Thwaites","year":"2006"},{"key":"b12","series-title":"IEEE Trans Biomed Eng","first-page":"230","article-title":"A real-time QRS detection algorithm","volume":"32","author":"Pan","year":"1985"},{"key":"b13","series-title":"Ann Noninvasive Electrocardiol","first-page":"151","article-title":"Heart rate variability: standards of measurement, physiological interpretation, and clinical use: Task Force of the European Society of Cardiology and the North American Society for Pacing and Electrophysiology","volume":"1","author":"Malik","year":"1996"},{"key":"b14","series-title":"Heart Rate Variability Analysis with the R package RHRV","author":"Mart\u00ednez","year":"2017"},{"key":"b15","series-title":"R: A Language and Environment for Statistical Computing","year":"2022"},{"key":"b16","series-title":"Psychoneuroendocrinology","first-page":"1305","article-title":"The relationship between heart rate variability and inflammatory markers in cardiovascular diseases","volume":"33","author":"Haensel","year":"2008"},{"key":"b17","series-title":"Circulation","first-page":"878","article-title":"Reduced heart rate variability and mortality risk in an elderly cohort. 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