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Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study
OBJECTIVES: The WHO designated individuals with low oxygen saturation, SpO2<94%, as severe SARS-CoV2 infection (COVID-19) and recommendations to seek care in a hospital setting were advised. A rapid, office-based method to select patients with severe COVID-19 who need intensive care was necessary...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689395/ https://www.ncbi.nlm.nih.gov/pubmed/38030244 http://dx.doi.org/10.1136/bmjopen-2023-073781 |
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author | Owens, Christopher Lamb, Chris Sanchez, Julio Quintero, Mariana Lopez-Yunez, Alfredo |
author_facet | Owens, Christopher Lamb, Chris Sanchez, Julio Quintero, Mariana Lopez-Yunez, Alfredo |
author_sort | Owens, Christopher |
collection | PubMed |
description | OBJECTIVES: The WHO designated individuals with low oxygen saturation, SpO2<94%, as severe SARS-CoV2 infection (COVID-19) and recommendations to seek care in a hospital setting were advised. A rapid, office-based method to select patients with severe COVID-19 who need intensive care was necessary during the peak of the pandemic. DESIGN, SETTING AND PARTICIPANTS: This is a prospective cohort study of patients with confirmed severe COVID-19 between September 2020 and April 2021. OUTCOME MEASURES AND ANALYSIS: Oxygen saturation was obtained at rest (SpO2r), following exertion from a 20 m walk test (SpO2e), and the difference was calculated (SpO2Δ). Radiographs and laboratory values were obtained and recorded. Logistic regression models were used to determine variables associated with hospitalisation. A lung injury score was used to quantify pulmonary involvement. RESULTS: Out of 103 patients enrolled with severe COVID-19 infection, 19 (18.4%) were admitted to the hospital (no deaths). Patients managed as outpatients had a standard treatment protocol. The SpO2Δ and SpO2e were associated with hospitalisation (p<0.005) while SpO2r was no different between non-hospitalised and hospitalised patients (90.7%±2.7% vs 90.8%±2.3%, p=0.87). By contrast, exertional SpO2e was significantly different between non-hospitalised and hospitalised (87.3%±2.6% vs 84.4%±3.4%, p=0.0005). The mean lung injury score was 11.0±3.5 (18-point scale) and did not discriminate against those who would need hospitalisation. Lower lung fields were significantly more involved than the upper (p<0.0001). All patients had elevated biomarkers of inflammation, C reactive protein (CRP) median 82.5 IQR (43–128.6) mg/L and evidence of elevated liver enzymes. A logistic regression model was constructed including SpO2Δ, CRP and alanine aminotransferase to predict hospitalisation. Only SpO2Δ was significant, p=0.012, 95% CI (1.128 to 2.704) and correctly classified 85.71% of patients who could remain at home or would need to receive treatment in the hospital. CONCLUSION: An office-based, 20 m walk test can help diverge patients with severe COVID-19 who need escalated care. Further, an aggressive standardised treatment protocol can be used to successfully manage patients outside of hospitals despite having severe COVID-19. |
format | Online Article Text |
id | pubmed-10689395 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-106893952023-12-02 Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study Owens, Christopher Lamb, Chris Sanchez, Julio Quintero, Mariana Lopez-Yunez, Alfredo BMJ Open Public Health OBJECTIVES: The WHO designated individuals with low oxygen saturation, SpO2<94%, as severe SARS-CoV2 infection (COVID-19) and recommendations to seek care in a hospital setting were advised. A rapid, office-based method to select patients with severe COVID-19 who need intensive care was necessary during the peak of the pandemic. DESIGN, SETTING AND PARTICIPANTS: This is a prospective cohort study of patients with confirmed severe COVID-19 between September 2020 and April 2021. OUTCOME MEASURES AND ANALYSIS: Oxygen saturation was obtained at rest (SpO2r), following exertion from a 20 m walk test (SpO2e), and the difference was calculated (SpO2Δ). Radiographs and laboratory values were obtained and recorded. Logistic regression models were used to determine variables associated with hospitalisation. A lung injury score was used to quantify pulmonary involvement. RESULTS: Out of 103 patients enrolled with severe COVID-19 infection, 19 (18.4%) were admitted to the hospital (no deaths). Patients managed as outpatients had a standard treatment protocol. The SpO2Δ and SpO2e were associated with hospitalisation (p<0.005) while SpO2r was no different between non-hospitalised and hospitalised patients (90.7%±2.7% vs 90.8%±2.3%, p=0.87). By contrast, exertional SpO2e was significantly different between non-hospitalised and hospitalised (87.3%±2.6% vs 84.4%±3.4%, p=0.0005). The mean lung injury score was 11.0±3.5 (18-point scale) and did not discriminate against those who would need hospitalisation. Lower lung fields were significantly more involved than the upper (p<0.0001). All patients had elevated biomarkers of inflammation, C reactive protein (CRP) median 82.5 IQR (43–128.6) mg/L and evidence of elevated liver enzymes. A logistic regression model was constructed including SpO2Δ, CRP and alanine aminotransferase to predict hospitalisation. Only SpO2Δ was significant, p=0.012, 95% CI (1.128 to 2.704) and correctly classified 85.71% of patients who could remain at home or would need to receive treatment in the hospital. CONCLUSION: An office-based, 20 m walk test can help diverge patients with severe COVID-19 who need escalated care. Further, an aggressive standardised treatment protocol can be used to successfully manage patients outside of hospitals despite having severe COVID-19. BMJ Publishing Group 2023-11-29 /pmc/articles/PMC10689395/ /pubmed/38030244 http://dx.doi.org/10.1136/bmjopen-2023-073781 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Public Health Owens, Christopher Lamb, Chris Sanchez, Julio Quintero, Mariana Lopez-Yunez, Alfredo Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study |
title | Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study |
title_full | Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study |
title_fullStr | Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study |
title_full_unstemmed | Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study |
title_short | Use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe COVID-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study |
title_sort | use of a rapid triage assessment tool to discriminate the need for hospitalisation in patients with severe covid-19 infection presenting to an outpatient clinic: a single-centre, prospective cohort study |
topic | Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689395/ https://www.ncbi.nlm.nih.gov/pubmed/38030244 http://dx.doi.org/10.1136/bmjopen-2023-073781 |
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