Ciaran Grafton-Clarke

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What is the value of community oximetry monitoring in people with SARS-CoV-2? – A prospective, open-label clinical study

Jane Wilcock ,

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Paper

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jane.wilcock@nhs.netBackground In people with COVID-19, hypoxia at the time of admission is known to be related to mortality. Monitoring of oxygen saturations (SpO2) is therefore an increasingly common part of community-based care, with the aim of improving the identification of adults who are deteriorating. We set out to investigate whether rigid SpO2 triggers, or absolute change in SpO2, is more indicative of deterioration in COVID-19.Methods A prospective, uncontrolled, open-label study in a large UK general practice was conducted between May and November 2020. Participants recorded twice daily oximetry and symptom diary for 14 days after test-confirmed COVID-19. Primary outcomes were the proportion of people whose SpO2 dropped to ≤ 94% and ≤ 92%, the average maximum reduction in SpO2, and admission to hospital. We also investigated the relationship between MRC Dyspnoea scale, modified Roth score, and SpO2 through correlation analyses.Results 52 participants were recruited, following which 41 participants completed the study. The average age was 45.9 years with 63.4% identifying as female. The mean maximum reduction in SpO2 was 2.8%. The average time to maximum reduction in SpO2 was 6.4 days. Nine participants (22.0%) had a reduction in SpO2 to ≤94%. Three of these had a reduction in SpO2 to ≤92%, for which all three were admitted to hospital. Modified Roth score and SpO2 were weakly positively correlated (.31). MRC dyspnoea scale score and SpO2 were moderately negatively correlated (-.53).Conclusions A reduction in SpO2 to ≤92% was found to be highly predictive for admission to hospital. Modified Roth score or MRC dyspnoea scale scores should not be used as proxy measures for oximetry. This study contributes to the ongoing narrative around community-based oximetry and provides insight and recommendations for those currently engaging in or planning to roll out similar schemes.Strengths and limitations of this study<ul class="ul1" style="font-size: medium;"><li class="li1" style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue";">This study is pragmatically designed to answer an important clinical question in primary care. </li><li class="li1" style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue";">This study focused on previously published values of SpO2 for triggering escalation of care and therefore provides answers based on current clinical practice. </li><li class="li1" style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue";">11 of the 52 patients who were recruited into the study did not return their oximeter or oximetry diary at the end of the study period. </li><li class="li1" style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue";">We did not validate the accuracy or reliability of the oximetry / symptom diaries, as these were self-completed by the participants themselves. </li><li class="li1" style="font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue";">Other than admission to hospital and mortality within the study period, no other clinical outcomes have been recorded. </li></ul>Funding statement This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.<p class="p2" style="margin: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> Competing interests Jane Wilcock has no competing interests to declare.Ciaran Grafton-Clarke has no competing interests to declare.Tessa Coulson has no competing interests to declare.<p class="p2" style="margin: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> Competing Interest Statement The authors have declared no competing interest.<p class="p2" style="margin: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> Clinical TrialIndependent UK GP research not registered. HRA IRAS project ID: 283310 Ethics review: 20/HRA/2326<p class="p2" style="margin: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> Clinical Protocols <p class="p4" style="margin: 0px 0px 2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; color: rgb(220, 161, 13);"><a href="https://www.researchgate.net/publication/348170563_What_is_the_value_of_community_oximetry_monitoring_in_people_with_SARS-CoV-2_-_A_prospective_open-label_clinical_study">https://www.researchgate.net/publication/348170563_What_is_the_value_of_community_oximetry_monitoring_in_people_with_SARS-CoV-2_-_A_prospective_open-label_clinical_study</a><p class="p2" style="margin: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> Funding Statement Funded by chief investigator <p class="p5" style="margin: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 23px;"> Author Declarations  I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:HRA ethics committee approval 20/HRA/2326All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.Yes<p class="p6" style="margin: 0px 0px 2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> <p class="p6" style="margin: 0px 0px 2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> <p class="p6" style="margin: 0px 0px 2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> <p class="p6" style="margin: 0px 0px 2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> <p class="p6" style="margin: 0px 0px 2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;"> <p class="p6" style="margin: 0px 0px 2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 18px; line-height: normal; font-family: "Helvetica Neue"; min-height: 22px;">

I spent five years at the University of Liverpool, graduating in 2018 with an MBChB (hons). During my time in the North West, I championed widening participation within my school through the formation of a multi-award-winning outreach programme. I also took interest in medical leadership and research, which has formed the basis of my progression through to foundation years. I am currently working within the academic foundation programme, specifically the medical leadership strand, for which I am currently working in Leicester. My time over the next 12 months will be split between clinical medicine, medical leadership development and clinical research. Having published in excess of twenty peer-reviewed publications, on topics ranging from oral cancer, cardiothoracic surgery, medical education and therapeutics, my long-term career goal is to become a cardiologist. I intend to progress through the MRCP examination over the forthcoming 24 months, for which the curriculum offered within the MSc programme is directly aligned. The MSc programme offered by the University of Edinburgh and the Royal College of Physicians of Edinburgh represents the highest quality education for students wishing to expand their knowledge, experience and appreciation of medicine as a science and art. The skills and knowledge I am gaining from engagement with this programme is translating to widespread and real benefits for the patient groups in which I serve, and the clinical teams in which I participate in. I thoroughly look forward to further study within the programme, and I would like to express my gratitude for the award of this scholarship.

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What is the value of community oximetry monitoring in people with SARS-CoV-2? – A prospective, open-label clinical study