Association between Prehospital Hypoxemia and Admission to Intensive Care Unit during the COVID-19 Pandemic: A Retrospective Cohort Study

Abstract

Background and Objectives: The aim of this study was to assess the association between prehospital peripheral oxygen saturation (SpO2) and intensive care unit (ICU) admission in confirmed or suspected coronavirus disease 19 (COVID-19) patients. Materials and Methods: We carried out a retrospective cohort study on patients requiring prehospital intervention between 11 March 2020 and 4 May 2020. All adult patients in whom a diagnosis of COVID-19 pneumonia was suspected by the prehospital physician were included. Patients who presented a prehospital confounding respiratory diagnosis and those who were not eligible for ICU admission were excluded. The main exposure was “Low SpO2” defined as a value < 90%. The primary outcome was 48-h ICU admission. Secondary outcomes were 48-h mortality and 30-day mortality. We analyzed the association between low SpO2 and ICU admission or mortality with univariable and multivariable regression models. Results: A total of 145 patients were included. A total of 41 (28.3%) patients had a low prehospital SpO2 and 21 (14.5%) patients were admitted to the ICU during the first 48 h. Low SpO2 was associated with an increase in ICU admission (OR = 3.4, 95% CI = 1.2–10.0), which remained significant after adjusting for sex and age (aOR = 5.2, 95% CI = 1.8–15.4). Mortality was higher in low SpO2 patients at 48 h (OR = 7.1 95% CI 1.3–38.3) and at 30 days (OR = 3.9, 95% CI 1.4–10.7). Conclusions: In our physician-staffed prehospital system, first low prehospital SpO2 values were associated with a higher risk of ICU admission during the COVID-19 pandemic.

A retrospective cohort study on COVID-19 at 2 Los Angeles hospitals: Older age, low triage oxygenation, and chronic kidney disease among the top risk factors associated with in-hospital mortality

“…Prehospital hypoxemia, or low oxygen levels, on room air obtained in triage in the Emergency Department or upon admission to the hospital has also been found to be an independent predictor of COVID-19 critical illness, ICU admission and in-hospital mortality [ 26 – 28 ]. As compared to traditional illnesses where hypoxemia correlates with significant dyspnea, or labored breathing, COVID-19-infected patients seem to have ‘silent hypoxia’ [ 29 ] where profoundly low oxygen levels are not commensurate with the patients’ relatively comfortable clinical appearance.…”

Association Between Prehospital Blood Glucose Levels and Outcomes in Patients With COVID-19 Infection: A Retrospective Cohort Study

“…Indeed, a large retrospective observational study showed that the inclusion of blood glucose assessment in the National Early Warning Score (NEWS) was associated with an improved identification of patients at risk of death [29]. In the specific context of COVID-19, dysglycaemia may represent a potential useful prehospital indicator in addition to classic parameters such as respiratory (SpO2, respiratory rate) or hemodynamic parameters [30,31]. This could help reduce ED length of stay by enabling more efficient patient disposition.…”

Contribution of Live Video to Physicians’ Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey

“…In addition, during the two waves of the pandemic, the organisation of hospitals in the canton of Geneva was reviewed, with the main public hospital (Geneva University Hospitals), which was defined as the “COVID-19 hospital”, receiving all patients with (or suspected of having) COVID-19, and the other hospitals or private clinics mainly receiving patients without COVID-19 [ 26 ].…”