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. 2020 Aug;27(8):681-692.
doi: 10.1111/acem.14053. Epub 2020 Jul 23.

Novel Use of Home Pulse Oximetry Monitoring in COVID-19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization

Sonia Shah  1 , Kaushal Majmudar  2 , Amy Stein  3 , Nita Gupta  1 , Spencer Suppes  1 , Marina Karamanis  1 , Joseph Capannari  1 , Sanjay Sethi  4 , Christine Patte  1
Affiliations

Novel Use of Home Pulse Oximetry Monitoring in COVID-19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization

Sonia Shah et al. Acad Emerg Med. 2020 Aug.

Abstract

Objectives: Our objective was to evaluate patient-reported oxygen saturation (SpO2 ) using pulse oximetry as a home monitoring tool for patients with initially nonsevere COVID-19 to identify need for hospitalization.

Methods: Patients were enrolled at the emergency department (ED) and outpatient testing centers. Each patient was given a home pulse oximeter and instructed to record their SpO2 every 8 hours. Patients were instructed to return to the ED for sustained home SpO2 < 92% or if they felt they needed emergent medical attention. Relative risk was used to assess the relation between hospitalization and home SpO2 < 92% in COVID-19-positive patients.

Results: We enrolled 209 patients with suspected COVID-19, of whom 77 patients tested positive for COVID-19 and were included. Subsequent hospitalization occurred in 22 of 77 (29%) patients. Resting home SpO2 < 92% was associated with an increased likelihood of hospitalization compared to SpO2 ≥ 92% (relative risk = 7.0, 95% confidence interval = 3.4 to 14.5, p < 0.0001). Home SpO2 < 92% was also associated with increased risk of intensive care unit admission, acute respiratory distress syndrome, and septic shock. In our cohort, 50% of patients who ended up hospitalized only returned to the ED for incidental finding of low home SpO2 without worsening of symptoms. One-third (33%) of nonhospitalized patients stated that they would have returned to the ED if they did not have a pulse oximeter to reassure them at home.

Conclusions: This study found that home pulse oximetry monitoring identifies need for hospitalization in initially nonsevere COVID-19 patients when a cutoff of SpO2 92% is used. Half of patients who ended up hospitalized had SpO2 < 92% without worsening symptoms. Home SpO2 monitoring also reduces unnecessary ED revisits.

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Figures

Figure 1
Figure 1
Patient enrollment. In accordance with our institutional review board, patients who withdrew consent or met exclusion criteria were not included. Of 209 who were enrolled, 77 were ultimately included in our study. RT‐PCR = reverse transcriptase–polymerase chain reaction.
Figure 2
Figure 2
Outcomes of COVID‐19–positive patients. SpO2 = home pulse oxygen saturation; ICU = intensive care unit. **This patient had resting SpO2 of 94% in the ED and was discharged to home.
Figure 3
Figure 3
Relative risk (RR) of hospitalization, ICU admission, development of ARDS, and development of septic shock in COVID‐19 patients with home SpO2 < 92%. ARDS = acute respiratory distress syndrome; ICU = intensive care unit; SpO2 = oxygen saturation.
Figure 4
Figure 4
Longitudinal home pulse oximeter readings. (A) Home SpO2 readings plotted over time at 6:00 am, 2:00 pm, and 10:00 pm in COVID‐19–positive patients who ended up hospitalized. Most patients had sudden drop below 92% in SpO2 readings rather than a gradual decline. (B) Home SpO2 readings plotted over time at 6:00 am, 2:00 pm, and 10:00 pm in COVID‐19–positive patients who were not hospitalized. SpO2 = oxygen saturation.
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References

    1. World Health Organization . Global Surveillance for Human Infection With Coronavirus Disease (COVID‐19). 2020. Available at: https://www.who.int/publications‐detail/global‐surveillance‐for‐human‐in.... Accessed May 17, 2020
    1. Chen J, Qi T, Liu L, et al. Clinical progression of patients with COVID‐19 in Shanghai, China. J Infect 2020;80:e1–e6. - PMC - PubMed
    1. Pilcher J, Ploen L, McKinstry S, et al. A multicentre prospective observational study comparing arterial blood gas values to those obtained by pulse oximeters used in adult patients attending Australian and New Zealand hospitals. BMC Pulm Med 2020;20:7. - PMC - PubMed
    1. Schneider J, Sweberg T. Acute respiratory failure. Crit Care Clin 2013;29:167–83. - PubMed
    1. Collins JA, Rudenski A, Gibson J, Howard L, O'Driscoll R. Relating oxygen partial pressure, saturation and content: the haemoglobin‐oxygen dissociation curve. Breathe (Sheff) 2015;11:194–201. - PMC - PubMed

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