Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department
Introduction: It is difficult to determine illness severity for coronavirus disease 2019 (COVID-19) patients, especially among stable-appearing emergency department (ED) patients. We evaluated patient outcomes among ED patients with a documented ambulatory oxygen saturation measurement. Methods: Thi...
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doaj-b8836e7636d54f2ead7c6784b82927bf2020-11-25T04:04:40ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182020-09-0121610.5811/westjem.2020.8.48701wjem-21-5Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency DepartmentArvin R. Akhavan0Joseph P. Habboushe1Rajneesh Gulati2Oluchi Iheagwara3Joanna Watterson4Shawn Thomas5Jordan L. Swartz6Christian A. Koziatek7David C. Lee8New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkNew York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New YorkIntroduction: It is difficult to determine illness severity for coronavirus disease 2019 (COVID-19) patients, especially among stable-appearing emergency department (ED) patients. We evaluated patient outcomes among ED patients with a documented ambulatory oxygen saturation measurement. Methods: This was a retrospective chart review of ED patients seen at New York University Langone Health during the peak of the COVID-19 pandemic in New York City. We identified ED patients who had a documented ambulatory oxygen saturation. We studied the outcomes of high oxygen requirement (defined as >4 liters per minute) and mechanical ventilation among admitted patients and bounceback admissions among discharged patients. We also performed logistic regression and compared the performance of different ambulatory oxygen saturation cutoffs in predicting these outcomes. Results: Between March 15–April 14, 2020, 6194 patients presented with fever, cough, or shortness of breath at our EDs. Of these patients, 648 (11%) had a documented ambulatory oxygen saturation, of which 165 (24%) were admitted. Notably, admitted and discharged patients had similar initial vital signs. However, the average ambulatory oxygen saturation among admitted patients was significantly lower at 89% compared to 96% among discharged patients (p<0.01). Among admitted patients with an ambulatory oxygen saturation, 30% had high oxygen requirements and 8% required mechanical ventilation. These rates were predicted by low ambulatory oxygen saturation (p<0.01). Among discharged patients, 50 (10%) had a subsequent ED visit resulting in admission. Although bounceback admissions were predicted by ambulatory oxygen saturation at the first ED visit (p<0.01), our analysis of cutoffs suggested that this association may not be clinically useful. Conclusion: Measuring ambulatory oxygen saturation can help ED clinicians identify patients who may require high levels of oxygen or mechanical ventilation during admission. However, it is less useful for identifying which patients may deteriorate clinically in the days after ED discharge and require subsequent hospitalization.https://escholarship.org/uc/item/92h9c2rm |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Arvin R. Akhavan Joseph P. Habboushe Rajneesh Gulati Oluchi Iheagwara Joanna Watterson Shawn Thomas Jordan L. Swartz Christian A. Koziatek David C. Lee |
spellingShingle |
Arvin R. Akhavan Joseph P. Habboushe Rajneesh Gulati Oluchi Iheagwara Joanna Watterson Shawn Thomas Jordan L. Swartz Christian A. Koziatek David C. Lee Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department Western Journal of Emergency Medicine |
author_facet |
Arvin R. Akhavan Joseph P. Habboushe Rajneesh Gulati Oluchi Iheagwara Joanna Watterson Shawn Thomas Jordan L. Swartz Christian A. Koziatek David C. Lee |
author_sort |
Arvin R. Akhavan |
title |
Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department |
title_short |
Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department |
title_full |
Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department |
title_fullStr |
Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department |
title_full_unstemmed |
Risk Stratification of COVID-19 Patients Using Ambulatory Oxygen Saturation in the Emergency Department |
title_sort |
risk stratification of covid-19 patients using ambulatory oxygen saturation in the emergency department |
publisher |
eScholarship Publishing, University of California |
series |
Western Journal of Emergency Medicine |
issn |
1936-9018 |
publishDate |
2020-09-01 |
description |
Introduction: It is difficult to determine illness severity for coronavirus disease 2019 (COVID-19) patients, especially among stable-appearing emergency department (ED) patients. We evaluated patient outcomes among ED patients with a documented ambulatory oxygen saturation measurement. Methods: This was a retrospective chart review of ED patients seen at New York University Langone Health during the peak of the COVID-19 pandemic in New York City. We identified ED patients who had a documented ambulatory oxygen saturation. We studied the outcomes of high oxygen requirement (defined as >4 liters per minute) and mechanical ventilation among admitted patients and bounceback admissions among discharged patients. We also performed logistic regression and compared the performance of different ambulatory oxygen saturation cutoffs in predicting these outcomes. Results: Between March 15–April 14, 2020, 6194 patients presented with fever, cough, or shortness of breath at our EDs. Of these patients, 648 (11%) had a documented ambulatory oxygen saturation, of which 165 (24%) were admitted. Notably, admitted and discharged patients had similar initial vital signs. However, the average ambulatory oxygen saturation among admitted patients was significantly lower at 89% compared to 96% among discharged patients (p<0.01). Among admitted patients with an ambulatory oxygen saturation, 30% had high oxygen requirements and 8% required mechanical ventilation. These rates were predicted by low ambulatory oxygen saturation (p<0.01). Among discharged patients, 50 (10%) had a subsequent ED visit resulting in admission. Although bounceback admissions were predicted by ambulatory oxygen saturation at the first ED visit (p<0.01), our analysis of cutoffs suggested that this association may not be clinically useful. Conclusion: Measuring ambulatory oxygen saturation can help ED clinicians identify patients who may require high levels of oxygen or mechanical ventilation during admission. However, it is less useful for identifying which patients may deteriorate clinically in the days after ED discharge and require subsequent hospitalization. |
url |
https://escholarship.org/uc/item/92h9c2rm |
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