tetano
Editor, Senior Moderator
J Am Coll Emerg Physicians Open
. 2021 Mar 17;2(2):e12407.
doi: 10.1002/emp2.12407. eCollection 2021 Apr.
Prehospital hypoxemia, measured by pulse oximetry, predicts hospital outcomes during the New York City COVID-19 pandemic
Elizabeth A Lancet[SUP] 1 2 [/SUP], Dario Gonzalez[SUP] 1 [/SUP], Nikolaos A Alexandrou[SUP] 1 [/SUP], Benjamin Zabar[SUP] 1 [/SUP], Pamela H Lai[SUP] 1 [/SUP], Charles B Hall[SUP] 2 [/SUP], James Braun[SUP] 1 [/SUP], Rachel Zeig-Owens[SUP] 2 3 [/SUP], Douglas Isaacs[SUP] 1 [/SUP], David Ben-Eli[SUP] 1 [/SUP], Nathan Reisman[SUP] 1 [/SUP], Bradley Kaufman[SUP] 1 [/SUP], Glenn Asaeda[SUP] 1 [/SUP], Michael D Weiden[SUP] 3 4 [/SUP], Anna Nolan[SUP] 3 5 [/SUP], Hugo Teo[SUP] 6 [/SUP], Eric Wei[SUP] 6 [/SUP], Shaw Natsui[SUP] 6 [/SUP], Christopher Philippou[SUP] 6 [/SUP], David J Prezant[SUP] 1 2 3 5 [/SUP]
Affiliations
Abstract
Objective: To determine if oxygen saturation (out-of-hospital SpO2), measured by New York City (NYC) 9-1-1 Emergency Medical Services (EMS), was an independent predictor of coronavirus disease 2019 (COVID-19) in-hospital mortality and length of stay, after controlling for the competing risk of death. If so, out-of-hospital SpO2 could be useful for initial triage.
Methods: A population-based longitudinal study of adult patients transported by EMS to emergency departments (ED) between March 5 and April 30, 2020 (the NYC COVID-19 peak period). Inclusion required EMS prehospital SpO2 measurement while breathing room air, transport to emergency department, and a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction test. Multivariable logistic regression modeled mortality as a function of prehospital SpO2, controlling for covariates (age, sex, race/ethnicity, and comorbidities). A competing risk model also was performed to estimate the absolute risks of out-of-hospital SpO2 on the cumulative incidence of being discharged from the hospital alive.
Results: In 1673 patients, out-of-hospital SpO2 and age were independent predictors of in-hospital mortality and length of stay, after controlling for the competing risk of death. Among patients ?66 years old, the probability of death was 26% with an out-of-hospital SpO2 >90% versus 54% with an out-of-hospital SpO2 ?90%. Among patients <66 years old, the probability of death was 11.5% with an out-of-hospital SpO2 >90% versus 31% with an out-of-hospital SpO2 ? 90%. An out-of-hospital SpO2 level ?90% was associated with over 50% decreased likelihood of being discharged alive, regardless of age.
Conclusions: Out-of-hospital SpO2 and age predicted in-hospital mortality and length of stay: An out-of-hospital SpO2 ?90% strongly supports a triage decision for immediate hospital admission. For out-of-hospital SpO2 >90%, the decision to admit depends on multiple factors, including age, resource availability (outpatient vs inpatient), and the potential impact of new treatments.
. 2021 Mar 17;2(2):e12407.
doi: 10.1002/emp2.12407. eCollection 2021 Apr.
Prehospital hypoxemia, measured by pulse oximetry, predicts hospital outcomes during the New York City COVID-19 pandemic
Elizabeth A Lancet[SUP] 1 2 [/SUP], Dario Gonzalez[SUP] 1 [/SUP], Nikolaos A Alexandrou[SUP] 1 [/SUP], Benjamin Zabar[SUP] 1 [/SUP], Pamela H Lai[SUP] 1 [/SUP], Charles B Hall[SUP] 2 [/SUP], James Braun[SUP] 1 [/SUP], Rachel Zeig-Owens[SUP] 2 3 [/SUP], Douglas Isaacs[SUP] 1 [/SUP], David Ben-Eli[SUP] 1 [/SUP], Nathan Reisman[SUP] 1 [/SUP], Bradley Kaufman[SUP] 1 [/SUP], Glenn Asaeda[SUP] 1 [/SUP], Michael D Weiden[SUP] 3 4 [/SUP], Anna Nolan[SUP] 3 5 [/SUP], Hugo Teo[SUP] 6 [/SUP], Eric Wei[SUP] 6 [/SUP], Shaw Natsui[SUP] 6 [/SUP], Christopher Philippou[SUP] 6 [/SUP], David J Prezant[SUP] 1 2 3 5 [/SUP]
Affiliations
- PMID: 33748809
- PMCID: PMC7967703
- DOI: 10.1002/emp2.12407
Abstract
Objective: To determine if oxygen saturation (out-of-hospital SpO2), measured by New York City (NYC) 9-1-1 Emergency Medical Services (EMS), was an independent predictor of coronavirus disease 2019 (COVID-19) in-hospital mortality and length of stay, after controlling for the competing risk of death. If so, out-of-hospital SpO2 could be useful for initial triage.
Methods: A population-based longitudinal study of adult patients transported by EMS to emergency departments (ED) between March 5 and April 30, 2020 (the NYC COVID-19 peak period). Inclusion required EMS prehospital SpO2 measurement while breathing room air, transport to emergency department, and a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction test. Multivariable logistic regression modeled mortality as a function of prehospital SpO2, controlling for covariates (age, sex, race/ethnicity, and comorbidities). A competing risk model also was performed to estimate the absolute risks of out-of-hospital SpO2 on the cumulative incidence of being discharged from the hospital alive.
Results: In 1673 patients, out-of-hospital SpO2 and age were independent predictors of in-hospital mortality and length of stay, after controlling for the competing risk of death. Among patients ?66 years old, the probability of death was 26% with an out-of-hospital SpO2 >90% versus 54% with an out-of-hospital SpO2 ?90%. Among patients <66 years old, the probability of death was 11.5% with an out-of-hospital SpO2 >90% versus 31% with an out-of-hospital SpO2 ? 90%. An out-of-hospital SpO2 level ?90% was associated with over 50% decreased likelihood of being discharged alive, regardless of age.
Conclusions: Out-of-hospital SpO2 and age predicted in-hospital mortality and length of stay: An out-of-hospital SpO2 ?90% strongly supports a triage decision for immediate hospital admission. For out-of-hospital SpO2 >90%, the decision to admit depends on multiple factors, including age, resource availability (outpatient vs inpatient), and the potential impact of new treatments.