Diagnostic accuracy of subjective dyspnoea in detecting hypoxaemia among outpatients with COVID-19: a retrospective cohort study.
COVID-19
infectious diseases
public health
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
08 03 2021
08 03 2021
Historique:
entrez:
19
5
2021
pubmed:
20
5
2021
medline:
22
5
2021
Statut:
epublish
Résumé
The majority of patients with mild-to-moderate COVID-19 can be managed using virtual care. Dyspnoea is challenging to assess remotely, and the accuracy of subjective dyspnoea measures in capturing hypoxaemia have not been formally evaluated for COVID-19. We explored the accuracy of subjective dyspnoea in diagnosing hypoxaemia in COVID-19 patients. This is a retrospective cohort study of consecutive outpatients with COVID-19 who met criteria for home oxygen saturation monitoring at a university-affiliated acute care hospital in Toronto, Canada from 3 April 2020 to 13 September 2020. Dyspnoea measures were treated as diagnostic tests, and we determined their sensitivity (SN), specificity (SP), negative/positive predictive value (NPV/PPV) and positive/negative likelihood ratios (+LR/-LR) for detecting hypoxaemia. In the primary analysis, hypoxaemia was defined by oxygen saturation <95%; the diagnostic accuracy of subjective dyspnoea was also assessed across a range of oxygen saturation cutoffs from 92% to 97%. During the study period, 89/501 (17.8%) of patients met criteria for home oxygen saturation monitoring, and of these 17/89 (19.1%) were diagnosed with hypoxaemia. The presence/absence of dyspnoea had limited accuracy for diagnosing hypoxaemia, with SN 47% (95% CI 24% to 72%), SP 80% (95% CI 68% to 88%), NPV 86% (95% CI 75% to 93%), PPV 36% (95% CI 18% to 59%), +LR 2.4 (95% CI 1.2 to 4.7) and -LR 0.7 (95% CI 0.4 to 1.1). The SN of dyspnoea was 50% (95% CI 19% to 81%) when a cut-off of Subjective dyspnoea measures have inadequate accuracy for ruling out hypoxaemia in high-risk patients with COVID-19. Safe home management of patients with COVID-19 should incorporate home oxygenation saturation monitoring.
Identifiants
pubmed: 34006036
pii: bmjopen-2020-046282
doi: 10.1136/bmjopen-2020-046282
pmc: PMC7941675
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e046282Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Am J Emerg Med. 2020 Oct;38(10):2243.e5-2243.e6
pubmed: 32471783
Crit Care. 2020 Apr 16;24(1):154
pubmed: 32299472
Med Princ Pract. 2007;16(5):378-83
pubmed: 17709927
Science. 2020 May 1;368(6490):455-456
pubmed: 32355007
Eur Respir J. 2015 Dec;46(6):1615-24
pubmed: 26493791
CMAJ Open. 2020 May 23;8(2):E407-E413
pubmed: 32447283
Crit Care. 2020 Jun 8;24(1):313
pubmed: 32513249
BMJ. 2020 Mar 26;368:m1091
pubmed: 32217556
Support Care Cancer. 2009 Apr;17(4):367-77
pubmed: 18719948
J Pain Symptom Manage. 2002 Jun;23(6):490-500
pubmed: 12067773
BMJ. 2020 Mar 25;368:m1182
pubmed: 32213507
Chin Med J (Engl). 2020 Jun 5;133(11):1261-1267
pubmed: 32209890
Ann Emerg Med. 2020 Oct;76(4):413-426
pubmed: 33012377
JAMA. 2020 Apr 7;323(13):1239-1242
pubmed: 32091533
Am J Respir Crit Care Med. 2020 May 15;201(10):1299-1300
pubmed: 32228035
Ann Am Thorac Soc. 2020 Sep;17(9):1040-1046
pubmed: 32521167
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
BMC Emerg Med. 2017 Apr 26;17(1):13
pubmed: 28441939
Pulm Circ. 2020 Jun 2;10(3):2045894020931702
pubmed: 32537129
Tidsskr Nor Laegeforen. 2020 Apr 11;140(7):
pubmed: 32378842
Clin Cardiol. 2016 Nov;39(11):636-639
pubmed: 27701750
Intensive Care Med. 2020 Jun;46(6):1099-1102
pubmed: 32291463
BMC Pulm Med. 2010 May 28;10:32
pubmed: 20509928
Am J Respir Crit Care Med. 2020 Aug 1;202(3):356-360
pubmed: 32539537