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

Authors

Sonia Shah
Kaushal Majmudar, Advocate Aurora HealthFollow
Amy Stein
Nita Gupta
Spencer Suppes
Marina Karamanis
Joseph Capannari
Sanjay Sethi
Christine Patte

Recommended Citation

Shah S, Majmudar K, Stein A, et al. Novel use of home pulse oximetry monitoring in covid-19 patients discharged from the emergency department identifies need for hospitalization. Acad Emerg Med. 2020;27(8):681-692.

Affiliations

Department of Gastroenterology, Advocate Lutheran General Hospital

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.

Document Type

Article

PubMed ID

32779828