Validation of home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19

Abstract

Background The early identification of deterioration in suspected COVID-19 patients managed at home enables a more timely clinical intervention, which is likely to translate into improved outcomes. We undertook an analysis of COVID-19 patients conveyed by ambulance to hospital to investigate how oxygen saturation and measurements of other vital signs correlate to patient outcomes, to ascertain if clinical deterioration can be predicted with simple community physiological monitoring. Methods A retrospective analysis of routinely collected clinical data relating to patients conveyed to hospital by ambulance was undertaken. We used descriptive statistics and predictive analytics to investigate how vital signs, measured at home by ambulance staff from the South Central Ambulance Service, correlate to patient outcomes. Information on patient comorbidities was obtained by linking the recorded vital sign measurements to the patient's electronic health record at the Hampshire Hospitals NHS Foundation Trust. ROC analysis was performed using cross-validation to evaluate, in a retrospective fashion, the efficacy of different variables in predicting patient outcomes. Results We identified 1,080 adults with a COVID-19 diagnosis who were conveyed by ambulance to either Basingstoke & North Hampshire Hospital or the Royal Hampshire County Hospital (Winchester) between March 1st and July 31st and whose diagnosis was clinically confirmed at hospital discharge. Vital signs measured by ambulance staff at first point of contact in the community correlated with patient short-term mortality or ICU admission. Oxygen saturations were the most predictive of mortality or ICU admission (AUROC 0.772 (95 % CI: 0.712-0.833)), followed by the NEWS2 score (AUROC 0.715 (95 % CI: 0.670-0.760), patient age (AUROC 0.690 (95 % CI: 0.642-0.737)), and respiration rate (AUROC 0.662 (95 % CI: 0.599-0.729)). Combining age with the NEWS2 score (AUROC 0.771 (95 % CI: 0.718-0.824)) or the measured oxygen saturation (AUROC 0.820 (95 % CI: 0.785-0.854)) increased the predictive ability but did not reach significance. Conclusions Initial oxygen saturation measurements (on air) for confirmed COVID-19 patients conveyed by ambulance correlated with short-term (30-day) patient mortality or ICU admission, AUROC: 0.772 (95% CI: 0.712-0.833). We found that even small deflections in oxygen saturations of 1-2% below 96% confer an increased mortality risk in those with confirmed COVID at their initial community assessments.

Remote management of covid-19 using home pulse oximetry and virtual ward support

“…Many patients hospitalised with acute covid-19 have severe hypoxia 478. Hypoxia, silent hypoxia, and the need for supplementary oxygen are all independent predictors of worse outcomes in covid-19 8910111213141516. Novel prognostic tools such as the 4C score have shown the importance of identifying hypoxia early,917 and there are physiological reasons for managing the complication promptly and actively 118…”

The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study

“…Likewise, in South Korea, analysis of data showed that later presentation was associated with poorer outcomes, and countries such as Singapore, which had a policy of early admission to hospital, had a very low fatality rate [ 6 , 7 ]. Additionally, delayed admission and level of presenting oxygen saturation (SpO 2 ) in English patients has been shown to predict outcome, with even relatively small reductions of SpO 2 of 95% and below being associated with increases in mortality [ 8 ].…”

Oxygen saturation instability in suspected covid-19 patients; contrasting effects of reduced VA/Q and shunt

“…Other groups have reported on SpO2 monitoring of at risk Covid-19 patients in a domestic “virtual ward” setting. One chose a threshold for admission of 2% less than a 96% target, [11]. Another did not find such monitoring useful because of variability of implementation, [12] whereas a third reported on remote monitoring of 26 patients after discharge from hospital with Covid-19,[13].…”