Penn Medicine Study: Pulse Oximeters Did Not Change Patient Outcomes in COVID-19 Surveillance Program
PHILADELPHIA CREAM- Using a pulse oximeter to measure oxygen levels is no better than simply regularly asking patients with COVID-19 if they’re short of breath, new research from the Perelman School of Medicine at the University finds. ‘University of Pennsylvania. Pulse oximeters have often been used because of fears that patients might notice their blood oxygen levels dropping dangerously. But people participating in Penn Medicine’s COVID Watch program — which uses automated text messages to keep tabs on recovering patients at home — had the same results whether or not they used COVID-19 measuring devices. oxygen. The results of this work have been published in the New England Journal of Medicine.
“Compared to remote monitoring of breathlessness with simple automated recordings, we showed that adding pulse oximetry did not save more lives or keep more people out of hospital,” said the study’s co-lead author, Anna Morgandoctor, medical director of the COVID Watch program and assistant professor of general internal medicine. “And having a pulse oximeter didn’t even make patients less anxious.”
COVID Monitoring launched at Penn Medicine in March 2020 to remotely monitor patients with COVID-19 who were well enough to stay home to recover. Twice a day for two weeks, text messages were automatically sent to these patients asking them how they were feeling and if they were having difficulty breathing, a condition officially known as dyspnea. If patients indicated more difficulty breathing, they would be called by a nurse who would refer the patient to the emergency room, arrange an urgent telemedicine appointment or suggest continued monitoring at home. Over 28,500 patients have been enrolled in the program since it went live.
“The program made it easy to identify the sickest patients who needed to be hospitalized and to keep the rest at home safely,” said David Asch, MD, executive director of the Center for Health Care Innovation and professor of medicine, medical ethics and health policy. “The program was associated with a 68% reduction in mortality, saving one life approximately every three days during peak enrollment early in the pandemic.”
But the question remained whether the program would be even better if it was based on the actual oxygen content of the blood rather than just whether the patients felt short of breath.
“At the start of the pandemic, there was a widespread theory that blood oxygen levels dropped before a COVID-19 patient became symptomatic and breathless,” said the co-lead author. study. Kathleen Lee, MD, adjunct assistant professor of emergency medicine. “Detecting this earlier with a home pulse oximeter could provide an opportunity to get patients at the verge of deterioration to the hospital more quickly and initiate urgent therapies to improve outcomes.”
The use of pulse oximeters was so intuitively appealing that the process was adopted even before this trial, the first randomized trial to test whether it actually worked.
“Several health systems, and even states like Vermont and countries like the UK, have incorporated pulse oximetry into the routine home management of patients with COVID-19, but there is little evidence to show that this strategy makes a difference,” the research said. principal researcher of the project Mr. Kit Delgado, MD, assistant professor of emergency medicine and epidemiology.
In this study, over 2,000 patients enrolled in COVID Watch between November 29, 2020 and February 5, 2021 were randomized to receive standard COVID Watch care or the same program with the addition of a pulse oximeter.
The pulse oximeter did not improve the situation of the patients. The researchers found no statistical difference in the study’s primary measure, the average number of days that enrolled patients were alive and out of hospital within 30 days of enrollment. For patients with pulse oximeters, the measurement was 29.4 days; for those without, it was 29.5. This lack of difference held across racial lines, as there was no noticeable difference between outcomes for black and white patients. This matters, because black patients have had disproportionately worse COVID-19 death rates during the pandemic, and recent search raised concerns that fingertip pulse oximeters may be less likely to detect low oxygen levels in patients with dark skin pigment compared to lighter skin pigment.
The researchers cautioned that their study examined the use of pulse oximeters as part of an established remote monitoring program, noting that patients do not have access to a system like COVID Watch or on-call clinicians. , self-monitoring with pulse oximeters may still be a reasonable approach until proven otherwise.
“Overall, these results suggest that a low-tech approach to symptom-based remote monitoring systems is just as good as a more expensive approach using additional devices. Automated text messaging is a great way for health systems to enable a small team of on-call nurses to manage large populations of COVID-19 patients,” said the co-principal investigator of the research project, Krisda Chaiyachati, MD, assistant professor of internal medicine and now physician responsible for value-based care and innovation at Verily. “There are plenty of other medical conditions where the same kind of approach could really help.”
This study was funded by the Patient-Centered Outcomes Research Institute (COVID-2020C2-10830), the National Institutes of Health (K23HD090272001, K08AG065444), and the Abramson Family Foundation.
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