Assessing the safety of home oximetry for COVID-19: a multisite retrospective observational study
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Abstract
To determine the safety and effectiveness of home oximetry monitoring pathways for patients with COVID-19 in the English National Health Service.
Design
Retrospective, multisite, observational study of home oximetry monitoring for patients with suspected or proven COVID-19.
Setting
This study analysed patient data from four COVID-19 home oximetry pilot sites in England across primary and secondary care settings.
Participants
A total of 1338 participants were enrolled in a home oximetry programme across four pilot sites. Participants were excluded if primary care data and oxygen saturations at rest at enrolment were not available. Data from 908 participants were included in the analysis.
Interventions
Home oximetry monitoring was provided to participants with a known or suspected diagnosis of COVID-19. Participants were enrolled following attendance to emergency departments, hospital admission or referral through primary care services.
Results
Of 908 patients enrolled into four different COVID-19 home oximetry programmes in England, 771 (84.9%) had oxygen saturations at rest of 95% or more, and 320 (35.2%) were under 65 years of age and without comorbidities. 52 (5.7%) presented to hospital and 28 (3.1%) died following enrolment, of which 14 (50%) had COVID-19 as a named cause of death. All-cause mortality was significantly higher in patients enrolled after admission to hospital (OR 8.70 (2.53–29.89)), compared with those enrolled in primary care. Patients enrolled after hospital discharge (OR 0.31 (0.15–0.68)) or emergency department presentation (OR 0.42 (0.20–0.89)) were significantly less likely to present to hospital than those enrolled in primary care.
Conclusions
This study finds that home oximetry monitoring can be a safe pathway for patients with COVID-19; and indicates increases in risk to vulnerable groups and patients with oxygen saturations <95% at enrolment, and in those enrolled on discharge from hospital. Findings from this evaluation have contributed to the national implementation of home oximetry across England.
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SciScore for 10.1101/2020.12.16.20248302: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The work was conducted as a service evaluation, as institutional Research Governance deemed that it did not require further ethics committee approval. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths & Limitations: The primary strength of this study is its system-level and patient-level impact, since this work evaluated a real-world pilot of a new clinical pathway. The project team …
SciScore for 10.1101/2020.12.16.20248302: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The work was conducted as a service evaluation, as institutional Research Governance deemed that it did not require further ethics committee approval. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths & Limitations: The primary strength of this study is its system-level and patient-level impact, since this work evaluated a real-world pilot of a new clinical pathway. The project team achieved an integrated partnership between academics, clinicians and policy makers. This enabled a direct pipeline from evidence generation to policy decision making; moreover, the efficiency with which the work was conducted was nationally important, as it was required to inform how the NHS would use home oximetry monitoring during the next wave of the pandemic. Impact was achieved through the unique composition of the evaluation team as well as the close relationship the team held to NHS leaders in home oximetry monitoring. The method for this work required novel data reporting from the pilot sites to the evaluation team and this was ensured through close collaboration with the individual sites. The most prevalent limitation related to data quality and completeness. The pilot sites varied in their routes of referral and in the clinical severity of the patients they enrolled. Furthermore, there was heterogeneity in the actual intervention across the sites, as some enrolled patients with suspected Covid-19, while others included patients who had received hospital treatment for Covid-19 and were subsequently discharged. Due to the rapid timescales of this evaluation and the pressured environment in which it took place, mandating full completeness in the data submitted was not possible,...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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