Your browser doesn't support javascript.
Diagnostic accuracy of subjective dyspnoea in detecting hypoxaemia among outpatients with COVID-19: a retrospective cohort study.
Berezin, Linor; Zhabokritsky, Alice; Andany, Nisha; Chan, Adrienne K; Estrada-Codecido, Jose; Gershon, Andrea; Lam, Philip W; Leis, Jerome A; MacPhee, Scott; Mubareka, Samira; Simor, Andrew E; Daneman, Nick.
  • Berezin L; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Zhabokritsky A; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Andany N; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Chan AK; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Estrada-Codecido J; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Gershon A; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Lam PW; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Leis JA; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • MacPhee S; Division of Respirology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Mubareka S; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Simor AE; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Daneman N; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Open ; 11(3): e046282, 2021 03 08.
Article in English | MEDLINE | ID: covidwho-1189880
ABSTRACT

OBJECTIVES:

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.

METHODS:

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%.

RESULTS:

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 <92% was used to define hypoxaemia. A modified Medical Research Council dyspnoea score >1 (SP 98%, 95% CI 88% to 100%), Roth maximal count <12 (SP 100%, 95% CI 75% to 100%) and Roth counting time <8 s (SP 93%, 95% CI 66% to 100%) had high SP that could be used to rule in hypoxaemia, but displayed low SN (≤50%).

CONCLUSIONS:

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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-046282

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-046282