Novel Use of Home Pulse Oximetry Monitoring in COVID‐19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization

Abstract

Objectives Our objective was to evaluate patient‐reported oxygen saturation (SpO2) using pulse oximetry as a home monitoring tool for patients with initially nonsevere COVID‐19 to identify need for hospitalization. Methods Patients were enrolled at the emergency department (ED) and outpatient testing centers. Each patient was given a home pulse oximeter and instructed to record their SpO2 every 8 hours. Patients were instructed to return to the ED for sustained home SpO2 < 92% or if they felt they needed emergent medical attention. Relative risk was used to assess the relation between hospitalization and home SpO2 < 92% in COVID‐19–positive patients. Results We enrolled 209 patients with suspected COVID‐19, of whom 77 patients tested positive for COVID‐19 and were included. Subsequent hospitalization occurred in 22 of 77 (29%) patients. Resting home SpO2 < 92% was associated with an increased likelihood of hospitalization compared to SpO2 ≥ 92% (relative risk = 7.0, 95% confidence interval = 3.4 to 14.5, p < 0.0001). Home SpO2 < 92% was also associated with increased risk of intensive care unit admission, acute respiratory distress syndrome, and septic shock. In our cohort, 50% of patients who ended up hospitalized only returned to the ED for incidental finding of low home SpO2 without worsening of symptoms. One‐third (33%) of nonhospitalized patients stated that they would have returned to the ED if they did not have a pulse oximeter to reassure them at home. Conclusions This study found that home pulse oximetry monitoring identifies need for hospitalization in initially nonsevere COVID‐19 patients when a cutoff of SpO2 92% is used. Half of patients who ended up hospitalized had SpO2 < 92% without worsening symptoms. Home SpO2 monitoring also reduces unnecessary ED revisits.

Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

“…Emerging international evidence has indicated that lower thresholds for oxygen saturation, are associated with worse patient outcomes 2 26 . In the case of our review, even though some authors argued that pulse oximetry identified the need for hospitalisation when using a cutoff of 92% 16 , we could not reach conclusions in relation to patient safety and the degree to which remote home monitoring models can conclusively identify cases of deterioration at an earlier stage in the disease trajectory. The main reasons were lack of standardised reporting across articles in relation to these outcome measures and how these were measured, as well as the limitation that none of the articles used comparators.…”

“…Medina et al 13 reported following up patients on the step-down pathway for 7 days post-discharge from hospital and those on the pre-admission pathway for 14 days. Shah et al 16 followed-up patients on their pre-admission pathway for 7 days. Hutchings et al 6 referred patients to their GP for follow-up after discharging them from the remote home monitoring pathway.…”

Pulse Oximetry as a Biomarker for Early Identification and Hospitalization of COVID‐19 Pneumonia

“…This month's AEM article confirms the utility of home pulse oximetry monitoring as a screening tool for COVID‐19 pneumonia 6 . This study validates pulse oximetry for determining the need for hospitalization.…”

“…Hopefully, such techniques will work even better if we identify pneumonia earlier with only mild hypoxia and before severe lung injury. This month's study by Shah et al 6 supports the growing body of literature that pulse oximetry monitoring should be a standard of care for discharging known or suspected COVID‐19 patients.…”

In Response to “The Novel Use of Home Pulse Oximetry”: An Australian Offer of Support

“…We write to thank Shah et al 1 for sharing their article “Novel Use of Home Pulse Oximetry Monitoring in COVID‐19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization” and provide an international perspective from Australia.…”