Use of the 1-minute sit to stand test in Patients presenting with suspected covid-19 to Assess need for hospital admission

ABSTRACT

Introduction The clinical presentation of Covid-19 varies widely with only a small proportion of those infected requiring hospitalisation. The ability to risk stratify patients upon presentation to the Emergency Department (ED) facilitates early safe discharge, with or without enhanced monitoring, which benefits hospital capacity management and infection control. In other lung parenchymal conditions oxygen desaturation during exercise has been used as an indicator of more severe disease. The exercise modality has typically been a field walking test or a bicycle or treadmill test which are impractical for delivery in ED. We investigated whether an alternative test, the 1-minute sit to stand test (1SST), was deliverable within an ED at the height of the COVID-19 pandemic. Methods During April to June 2020 at two large hospitals we performed 1SST in 201 people presenting with suspected Covid-19 and measured test performance (reps) plus change in pulse and oxygen saturations. Subsequently we identified clinical outcomes for all individuals diagnosed with Covid-19. A positive test was defined as 4% desaturation. Results The test was deliverable with 193/201 (96%) able to complete (2 were too unsteady, 6 failed to complete the minimum 5 reps). 111 (55%) were female, mean age of 49 (SD 16) years and an average of 17 (SD 7) reps completed. Mean fall in saturations was-1.6% and rise in pulse was 22. 34 people were diagnosed with Covid-19 based on a) positive swab or b) negative swab but diagnosed with 'clinical Covid-19' by a senior clinician based on clinical and radiological features. 1 person was unable to complete the 1SST test. The outcomes for people with a positive or negative test are shown in the table 1. In the early part of the study we were only able to swab people admitted to hospital so data from 109 further people is not included in the primary analysis. Conclusion The 1SST is feasible for people presenting acutely with Covid-19. It effectively identifies exercise induced oxygen desaturation and therefore augments the decision making relating to hospital admission.