Pulse oximetry in low-resource settings during the COVID-19 pandemic

Starr, Nichole; Rebollo, Daniela; Asemu, Yohannes Molla; Akalu, Leulayehu; Mohammed, H; Menchamo, Misrak Woldeyohannes; Melese, Eyayelem; Bitew, Senait; Wilson, Iain; Tadesse, Mahelet; Weiser, Thomas

doi:10.1016/s2214-109x(20)30287-4

Cited by 40 publications

(34 citation statements)

References 6 publications

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“…The tool is intended for frontline use and, as such, does not include clinical inputs that may take significant time to obtain or may be completely unavailable in LRS EUs, such as laboratory and imaging investigations. One version of the AFEM-CMS does, however, include pulse oximetry, which has been found to be a strong predictor of poor outcomes in COVID-19 patients but has variable availability in LMICs [ 16 24 25 26 27 ]. Both versions of the tool have good discriminatory power, although associated confidence intervals are somewhat wide.…”

Section: Discussionmentioning

confidence: 99%

“…Available literature suggests that demographics, comorbidities, signs and symptoms, vital signs, and blood glucose testing can feasibly be collected in most LRS EUs, while laboratory investigations and imaging generally are not [ 16 17 18 ]. Peripheral oxygen saturation—highlighted in many studies to be a key indicator of poor outcomes in COVID-19 [ 24 25 ] —has mixed but increasing availability [ 16 26 27 ]. In line with this study’s aim to develop a mortality scale that is widely applicable across LRS, no laboratory and imaging data were considered for inclusion in this scale.…”

Section: Methodsmentioning

confidence: 99%

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Derivation of a Contextually-Appropriate COVID-19 Mortality Scale for Low-Resource Settings

Pigoga

Omer

Wallis

2021

Annals of Global Health

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Background: In many low- and middle-income countries, where vaccinations will be delayed and healthcare systems are underdeveloped, the COVID-19 pandemic will continue for the foreseeable future. Mortality scales can aid frontline providers in low-resource settings (LRS) in identifying those at greatest risk of death so that limited resources can be directed towards those in greatest need and unnecessary loss of life is prevented. While many prognostication tools have been developed for, or applied to, COVID-19 patients, no tools to date have been purpose-designed for, and validated in, LRS. Objectives: This study aimed to develop a pragmatic tool to assist LRS frontline providers in evaluating in-hospital mortality risk using only easy-to-obtain demographic and clinical inputs. Methods: Machine learning was used on data from a retrospective cohort of Sudanese COVID-19 patients at two government referral hospitals to derive contextually appropriate mortality indices for COVID-19, which were then assessed by C-indices. Findings: Data from 467 patients were used to derive two versions of the AFEM COVID-19 Mortality Scale (AFEM-CMS), which evaluates in-hospital mortality risk using demographic and clinical inputs that are readily obtainable in hospital receiving areas. Both versions of the tool include age, sex, number of comorbidities, Glasgow Coma Scale, respiratory rate, and systolic blood pressure; in settings with pulse oximetry, oxygen saturation is included and in settings without access, heart rate is included. The AFEM-CMS showed good discrimination: the model including pulse oximetry had a C-statistic of 0.775 (95% CI: 0.737–0.813) and the model excluding it had a C-statistic of 0.719 (95% CI: 0.678–0.760). Conclusions: In the face of an enduring pandemic in many LRS, the AFEM-CMS serves as a practical solution to aid frontline providers in effectively allocating healthcare resources. The tool’s generalisability is likely narrow outside of similar extremely LRS settings, and further validation studies are essential prior to broader use.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Derivation of a Contextually-Appropriate COVID-19 Mortality Scale for Low-Resource Settings

Pigoga

Omer

Wallis

2021

Annals of Global Health

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“…Directing efforts toward procuring and maintaining working blood oxygen saturation monitoring equipment may be an effective means of improving triage accuracy; however, it is essential that tools be made available with and without this input, as blood oxygen saturation monitoring equipment may remain limited in availability in LMICs. 39,40 Availability, feasibility, affordability, and safety. Both triage and scoring tools that are based on laboratory studies and imaging may have limited utility in low-resource settings that lack access to advanced testing.…”

Section: Questionsmentioning

confidence: 99%

Section: Questionsmentioning

confidence: 99%

Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries

Barros

Pigoga

Chea

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Effective identification and prognostication of severe COVID-19 patients presenting to healthcare facilities are essential to reducing morbidity and mortality. Low- and middle-income country (LMIC) facilities often suffer from restrictions in availability of human resources, laboratory testing, medications, and imaging during routine functioning, and such shortages may worsen during times of surge. Low- and middle-income country healthcare providers will need contextually appropriate tools to identify and triage potential COVID-19 patients. We report on a series of LMIC-appropriate recommendations and suggestions for screening and triage of COVID-19 patients in LMICs, based on a pragmatic, experience-based appraisal of existing literature. We recommend that all patients be screened upon first contact with the healthcare system using a locally approved questionnaire to identify individuals who have suspected or confirmed COVID-19. We suggest that primary screening tools used to identify individuals who have suspected or confirmed COVID-19 include a broad range of signs and symptoms based on standard case definitions of COVID-19 disease. We recommend that screening include endemic febrile illness per routine protocols upon presentation to a healthcare facility. We recommend that, following screening and implementation of appropriate universal source control measures, suspected COVID-19 patients be triaged with a triage tool appropriate for the setting. We recommend a standardized severity score based on the WHO COVID-19 disease definitions be assigned to all suspected and confirmed COVID-19 patients before their disposition from the emergency unit. We suggest against using diagnostic imaging to improve triage of reverse transcriptase (RT)-PCR–confirmed COVID-19 patients, unless a patient has worsening respiratory status. We suggest against the use of point-of-care lung ultrasound to improve triage of RT-PCR–confirmed COVID-19 patients. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients who are RT-PCR negative but have moderate to severe symptoms and are suspected of a false-negative RT-PCR with high risk of disease progression. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients with moderate or severe clinical features who are without access to RT-PCR testing for SARS-CoV-2.

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“…Summary of the guidelines in various countries is given in Table 1 . Therefore, all countries may consider widespread use of oximetry in COVID-19 patients to assist in triaging [ 17 ] as eventually governments would have to resort to strategies to enable home/primary care management of mild COVID-19 cases to ease pressure on hospitals.…”

Section: Pulse Oximetry and Covid-19mentioning

confidence: 99%

A proposal to make the pulse oximetry as omnipresent as thermometry in public health care systems

Singh

Kataria

Das

et al. 2020

Journal of Global Health

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Pulse oximetry in low-resource settings during the COVID-19 pandemic

Cited by 40 publications

References 6 publications

Derivation of a Contextually-Appropriate COVID-19 Mortality Scale for Low-Resource Settings

Derivation of a Contextually-Appropriate COVID-19 Mortality Scale for Low-Resource Settings

Pragmatic Recommendations for Identification and Triage of Patients with COVID-19 Disease in Low- and Middle-Income Countries

A proposal to make the pulse oximetry as omnipresent as thermometry in public health care systems

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