Prehospital hypoxemia, measured by pulse oximetry, predicts hospital outcomes during the New York City COVID-19 pandemic.

Details

• Personal Author:
  Alexandrou NA ; Asaeda G ; Ben-Eli D ; Braun J ; Gonzalez D ; Hall CB ; Isaacs D ; Kaufman B ; Lai PH ; Lancet EA ; Natsui S ; Nolan A ; Philippou C ; Prezant DJ ; Reisman N ; Teo H ; Wei E ; Weiden MD ; Zabar B ; Zeig-Owens R
• Description:
  Objective: To determine if oxygen saturation (out-of-hospital SpO2), measured by New York City (NYC) 9-1-1 Emergency Medical Services (EMS), was an independent predictor of coronavirus disease 2019 (COVID-19) in-hospital mortality and length of stay, after controlling for the competing risk of death. If so, out-of-hospital SpO2 could be useful for initial triage. Methods: A population-based longitudinal study of adult patients transported by EMS to emergency departments (ED) between March 5 and April 30, 2020 (the NYC COVID-19 peak period). Inclusion required EMS prehospital SpO2 measurement while breathing room air, transport to emergency department, and a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction test. Multivariable logistic regression modeled mortality as a function of prehospital SpO2, controlling for covariates (age, sex, race/ethnicity, and comorbidities). A competing risk model also was performed to estimate the absolute risks of out-of-hospital SpO2 on the cumulative incidence of being discharged from the hospital alive. Results: In 1673 patients, out-of-hospital SpO2 and age were independent predictors of in-hospital mortality and length of stay, after controlling for the competing risk of death. Among patients =66 years old, the probability of death was 26% with an out-of-hospital SpO2 >90% versus 54% with an out-of-hospital SpO2 ≤90%. Among patients <66 years old, the probability of death was 11.5% with an out-of-hospital SpO2 >90% versus 31% with an out-of-hospital SpO2 ≤ 90%. An out-of-hospital SpO2 level =90% was associated with over 50% decreased likelihood of being discharged alive, regardless of age. Conclusions: Out-of-hospital SpO2 and age predicted in-hospital mortality and length of stay: An out-of-hospital SpO2 ≤90% strongly supports a triage decision for immediate hospital admission. For out-of-hospital SpO2 >90%, the decision to admit depends on multiple factors, including age, resource availability (outpatient vs inpatient), and the potential impact of new treatments. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Delivery Of Health Care Emergency Responders Occupational Health Safety Viral Diseases
• Keywords:
  Viral diseases; Infectious diseases; Coronavirus; COVID-19; SARS-CoV-2; Oxygen levels; Population based studies; Longitudinal study; Emergency care; Medical care
• ISSN:
  2688-1152
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  2
• Issue:
  2
• NIOSHTIC Number:
  nn:20064976
• Citation:
  J Am Coll Emerg Physicians Open 2021 Mar; 2(2):e12407
• Contact Point Address:
  David Prezant, MD, Office of Medical Affairs, Fire Department of the City of New York, 9 MetroTech Center, Brooklyn, NY 11201, USA
• Email:
  David.Prezant@fdny.nyc.gov
• Federal Fiscal Year:
  2021
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  True
• Start Date:
  20170701
• Source Full Name:
  Journal of the American College of Emergency Physicians Open
• End Date:
  20260630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:dd0782bbf4e10ee8731e263b7a429b291a50aad48e375901719ea2e226883e09b6b21c9909b1dcaf6a273be8a0b186487fe5ab4c2fcd4cae3f3acfcd1e171cc3
• Download URL:
  https://stacks.cdc.gov/view/cdc/249292/cdc_249292_DS1.pdf
• File Type:
  [PDF - 344.31 KB ]