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

Validation of home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19
Validation of home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19
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.
Inada-Kim, Matthew
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Chmiel, Francis
2de259aa-a5eb-460c-bfbf-8b44ed02e2bd
Boniface, Michael
f30bfd7d-20ed-451b-b405-34e3e22fdfba
Pocock, Helen
2380e94b-4916-4498-beac-dba8d2971bf4
Black, John J.M.
c9cf4036-ec61-4d6c-bf17-58cf338fdf06
Deakin, Charles D.
f308bd7c-4c95-4b55-8983-8237cde25967
Inada-Kim, Matthew
80f1afd6-cc55-4dd5-9d5b-a87567054904
Chmiel, Francis
2de259aa-a5eb-460c-bfbf-8b44ed02e2bd
Boniface, Michael
f30bfd7d-20ed-451b-b405-34e3e22fdfba
Pocock, Helen
2380e94b-4916-4498-beac-dba8d2971bf4
Black, John J.M.
c9cf4036-ec61-4d6c-bf17-58cf338fdf06
Deakin, Charles D.
f308bd7c-4c95-4b55-8983-8237cde25967

Inada-Kim, Matthew, Chmiel, Francis, Boniface, Michael, Pocock, Helen, Black, John J.M. and Deakin, Charles D. (2020) Validation of home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19. medRxiv. (doi:10.1101/2020.11.06.20225938v1). (Submitted)

Record type: Article

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.

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Submitted date: 8 November 2020

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Local EPrints ID: 444869
URI: http://eprints.soton.ac.uk/id/eprint/444869
PURE UUID: 1bb14702-8cb1-42ca-a98b-441ccff37e51
ORCID for Michael Boniface: ORCID iD orcid.org/0000-0002-9281-6095

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Date deposited: 09 Nov 2020 17:30
Last modified: 18 Feb 2021 16:57

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Contributors

Author: Matthew Inada-Kim
Author: Francis Chmiel
Author: Helen Pocock
Author: John J.M. Black
Author: Charles D. Deakin

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