BACKGROUND: The coronavirus disease 2019 (COVID-19) results in hypoxia in around a fifth of adult patients. Severe hypoxia in the absence of visible respiratory distress ('silent hypoxia') is increasingly recognised in these patients. There are no published data evaluating lowest recorded pre-hospital oxygen saturation or pre-hospital National Early Warning Score 2 (NEWS2) as a predictor of outcome in patients with COVID-19. METHODS: In this retrospective service evaluation, we included adult inpatients with laboratory confirmed COVID-19 who were discharged from hospital or who died in hospital between 12 March and 28 April 2020 (n = 143). Pre-hospital and in-hospital data were extracted and analysed to explore risk factors associated with in-hospital mortality to inform local triage and emergency management. RESULTS: The lowest recorded pre-hospital oxygen saturation was an independent predictor of mortality when controlling for age, gender and history of COPD. A 1% reduction in pre-hospital oxygen saturation increased the odds of death by 13% (OR 1.13, p < 0.001). Lower pre-hospital oxygen saturation predicted mortality after adjusting for the pre-hospital NEWS2 (OR for a 1% reduction in pre-hospital oxygen saturation 1.09, p = 0.02). The pre-hospital NEWS2 was higher in those who died (Median 9; IQR 7-10; n = 24) than in those who survived to discharge (Median 6; IQR 5-8; n = 63). CONCLUSION: This service evaluation suggests that the lowest recorded pre-hospital oxygen saturation may be an independent predictor of mortality in COVID-19 patients. Lowest pre-hospital oxygen saturation should be recorded and used in the assessment of patients with suspected COVID-19 in pre-hospital and emergency department triage settings.
BACKGROUND: The coronavirus disease 2019 (COVID-19) results in hypoxia in around a fifth of adult patients. Severe hypoxia in the absence of visible respiratory distress ('silent hypoxia') is increasingly recognised in these patients. There are no published data evaluating lowest recorded pre-hospital oxygen saturation or pre-hospital National Early Warning Score 2 (NEWS2) as a predictor of outcome in patients with COVID-19. METHODS: In this retrospective service evaluation, we included adult inpatients with laboratory confirmed COVID-19 who were discharged from hospital or who died in hospital between 12 March and 28 April 2020 (n = 143). Pre-hospital and in-hospital data were extracted and analysed to explore risk factors associated with in-hospital mortality to inform local triage and emergency management. RESULTS: The lowest recorded pre-hospital oxygen saturation was an independent predictor of mortality when controlling for age, gender and history of COPD. A 1% reduction in pre-hospital oxygen saturation increased the odds of death by 13% (OR 1.13, p < 0.001). Lower pre-hospital oxygen saturation predicted mortality after adjusting for the pre-hospital NEWS2 (OR for a 1% reduction in pre-hospital oxygen saturation 1.09, p = 0.02). The pre-hospital NEWS2 was higher in those who died (Median 9; IQR 7-10; n = 24) than in those who survived to discharge (Median 6; IQR 5-8; n = 63). CONCLUSION: This service evaluation suggests that the lowest recorded pre-hospital oxygen saturation may be an independent predictor of mortality in COVID-19 patients. Lowest pre-hospital oxygen saturation should be recorded and used in the assessment of patients with suspected COVID-19 in pre-hospital and emergency department triage settings.
Authors: Francisco Martín-Rodríguez; Ancor Sanz-García; Lorena Ortega Moreno; Carlos Del Pozo Vegas; Miguel A Castro-Villamor; José L Martín-Conty; Raúl López-Izquierdo; Guillermo Ortega Rabbione Journal: Emergencias Date: 2020-06 Impact factor: 3.881
Authors: Robert Verity; Lucy C Okell; Ilaria Dorigatti; Peter Winskill; Charles Whittaker; Natsuko Imai; Gina Cuomo-Dannenburg; Hayley Thompson; Patrick G T Walker; Han Fu; Amy Dighe; Jamie T Griffin; Marc Baguelin; Sangeeta Bhatia; Adhiratha Boonyasiri; Anne Cori; Zulma Cucunubá; Rich FitzJohn; Katy Gaythorpe; Will Green; Arran Hamlet; Wes Hinsley; Daniel Laydon; Gemma Nedjati-Gilani; Steven Riley; Sabine van Elsland; Erik Volz; Haowei Wang; Yuanrong Wang; Xiaoyue Xi; Christl A Donnelly; Azra C Ghani; Neil M Ferguson Journal: Lancet Infect Dis Date: 2020-03-30 Impact factor: 25.071
Authors: Liang En Wee; Yvonne Fu Zi Chan; Neville Wei Yang Teo; Benjamin Pei Zhi Cherng; Siew Yee Thien; Hei Man Wong; Limin Wijaya; Song Tar Toh; Thuan Tong Tan Journal: Eur Arch Otorhinolaryngol Date: 2020-04-24 Impact factor: 2.503
Authors: Anne Pullyblank; Alison Tavaré; Hannah Little; Emma Redfern; Hein le Roux; Matthew Inada-Kim; Kate Cheema; Adam Cook Journal: Br J Gen Pract Date: 2020-05-28 Impact factor: 5.386