Remote Risk-Stratification of Dyspnoea in Acute Respiratory Disorders: A Systematic Review of the Literature

Abstract

IntroductionSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19, constitutes a public health emergency of international concern. The virus has spread globally through aerosol and contact transmission since the discovery of the SARS-CoV-2 in December 2019 in Wuhan, China. 1 As of 8 October 2020, 36,002,827 cases of COVID-19 have been reported worldwide, including 1,049,810 deaths. 2 The majority of early reported cases had the common symptoms of fever, dry cough and dyspnoea, as well as less common symptoms of headache, myalgia and sputum production. Computerised tomography (CT) scans showed bilateral lung opacities in almost all patients. 3 A meta-analysis of risk factors of critical COVID-19 patients showed that patients with dyspnoea were more likely to deteriorate into a critical condition than those who presented with fever only. There was an increased risk among the elderly (especially males over 65 years) and patients with comorbidities, such as diabetes, hypertension, cardiovascular and respiratory disease. 4 The assessment of dyspnoea is therefore an essential part of managing patients presenting with suspected COVID-19.The pandemic has placed increasing strain on scarce healthcare resources such as hospital beds and clinician time. This has been due to both increased demand and the need for stringent infection control procedures. As a result, many countries have relied on primary care systems to reduce the fl ow of patients through hospital emergency departments.A large amount of community-based diagnosis and triage of COVID-19 is currently being performed by video and telephone consultation. This has presented clinicians with a new challenge in risk-stratifying patients with shortness of breath. Dyspnoea is a diverse symptom and can be present in those who are critically ill but also in the worried well. Objective modes of assessment are required to differentiate these patient groups.The transformation of primary care from face-to-face to remote consultations has been aided by technology such as

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

“…Indeed, the measurement of respiratory rate, the search for accessory muscle use or cyanosis, are clearly facilitated by visualisation of the patient. This has been demonstrated in several studies, especially in the paediatric context [ 20 , 32 , 33 ].…”

“…There are fifteen ambulance bases scattered throughout the canton of Geneva that operate according to the proximity of the base to the emergency site. The second level consists of a Mobile Emergency and Resuscitation Service or SMUR, i.e., a light vehicle that operates with a certified paramedic and an emergency physician in training with at least 2 years of experience [ 20 ]. To assist this junior emergency physicians or if the SMUR is already busy with another emergency event, specialised senior emergency physicians are available 24 h a day, 7 days a week to intervene on the spot (third level).…”

“…The COVID-19 pandemic was a catalyst in the use of live video as this capability limited the necessity of physician-patient contact and helped meet the increased demands placed on services during this period [ 18 ]. The use of live video during the pandemic subsequently became increasingly prevalent and helped improve quality of care, in particular in the detection of respiratory distress and identifying the requirement for emergency care [ 19 , 20 ].…”

Contribution of Live Video to Physicians’ Remote Assessment of Suspected COVID19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey

“…The second level consists of a Mobile Emergency and Resuscitation Service or SMUR, i.e. a light vehicle that operates with a certified paramedic and an emergency physician in training with at least 2 years of experience [20]. To assist this junior emergency physicians or if the SMUR is already busy with another emergency event, specialised senior emergency physicians are available 24 hours a day, 7 days a week to intervene on the spot (third level).…”

“…The COVID19 pandemic was a catalyst in the use of live video as this capability limited the necessity of physician-patient contact and helped meet the increased demands placed on services during this period [18]. The use of live video during the pandemic subsequently becomes increasingly prevalent and helped improve quality of care, in particular in the detection of respiratory distress and identify the requirement for emergency care [19,20].…”