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Observational Study
. 2021 Oct;16(7):1959-1965.
doi: 10.1007/s11739-021-02675-2. Epub 2021 Mar 1.

Role of ROX index in the first assessment of COVID-19 patients in the emergency department

Alice Gianstefani  1 , Gabriele Farina  2 , Veronica Salvatore  2 , Francesca Alvau  2 , Maria Laura Artesiani  2 , Sara Bonfatti  2 , Francesca Campinoti  2 , Ilaria Caramella  2 , Michele Ciordinik  2 , Andrea Lorusso  2 , Sara Nanni  2 , Daniela Nizza  2 , Stefano Nava  3 , Fabrizio Giostra  2
Affiliations
Observational Study

Role of ROX index in the first assessment of COVID-19 patients in the emergency department

Alice Gianstefani et al. Intern Emerg Med. 2021 Oct.

Abstract

During the first outbreak of Coronavirus disease 2019 (COVID-19) Emergency Departments (EDs) were overcrowded. Hence, the need for a rapid and simple tool to support clinical decisions, such as the ROX index (Respiratory rate - OXygenation), defined as the ratio of peripheral oxygen saturation and fraction of inspired oxygen, to respiratory rate. The aim of the study was to evaluate the accuracy of the ROX index in predicting hospitalization and mortality in patients with a diagnosis of COVID-19 in the ED. The secondary outcomes were to assess the number of readmissions and the variations in the ROX index between the first and the second admission. This was an observational prospective monocentric study, carried out in the ED of Sant'Orsola-Malpighi Hospital in Bologna, Italy. Five hundred and fifty-four consecutive patients with COVID-19 were enrolled and the ROX index was calculated. Patients were followed until hospital discharge or death. A ROX index value < 25.7 was associated with hospitalization (area under the curve [AUC] = 0.737, 95% CI 0.696-0.779, p < 0.001). The ROX index < 22.3 was statistically related to higher 30-day mortality (AUC = 0.764, 95% CI 0.708-0.820, p < 0.001). Eight patients were discharged and returned to the ED within the subsequent 7 days, their mean ROX index was 30.3 (6.2; range 21.9-39.4) at the first assessment and 24.6 (5.5; 14.5-29.5) at the second assessment, (p = 0.012). The ROX index, together with laboratory, imaging and clinical findings, correlated with the need for hospital admission, mechanical ventilation and mortality risk in COVID-19 patients.

Keywords: COVID-19; Emergency department; Pandemic; ROX index.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a Receiver operating characteristic (ROC) analysis of the ROX index in predicting hospitalization (AUC 0.737; 95% CI, 0.696 – 0.779; p < 0.001). b Receiver operating characteristic (ROC) analysis of the ROX index in predicting 30-day mortality (AUC 0.764; 95% CI, 0.708–0.820; p < 0.001)
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