Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19.
Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19.
复制标题
DOI：
10.1001/jamanetworkopen.2023.30856
复制
发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
--
作者：
脉搏血氧仪对血氧饱和度的高估是否与新冠肺炎特定治疗的延迟交付、再次住院、住院时间或住院死亡率有关，以及种族和民族之间的相关性是否有所不同？在这项对24名 504患者同时测量脉搏血氧饱和度和动脉血氧饱和度的队列研究中，脉搏血氧饱和度计更常高估少数民族患者的动脉血氧饱和度，并导致黑人患者比白人患者延迟认识到需要新冠肺炎治疗。在入院时不立即需要新冠肺炎治疗的8,635名患者中，脉搏血氧饱和度高估与新冠肺炎治疗的延迟交付和再次住院风险增加有关，与患者种族无关。这些结果表明，尽管用脉搏血氧仪测量血氧饱和度存在种族和民族差异，但高估可能会增加再次住院的风险，而不考虑患者的种族。这项队列研究对在新冠肺炎急性护理机构接受治疗的美国成年人进行了研究，调查了脉搏血氧饱和度高估与按种族和民族分层的临床结果之间的关系。许多脉搏血氧仪被证明高估了有色人种的血氧饱和度，这种现象具有潜在的临床意义。高估血氧饱和度与新冠肺炎给药时间和临床结果之间的关系尚不清楚。目的：探讨脉搏血氧饱和度高估与新冠肺炎治疗延迟、住院时间、再住院风险及住院死亡率之间的关系。这项队列研究包括2020年3月至2021年10月期间在美国186家急性护理机构因新冠肺炎住院的患者，他们至少测量了1次功能性动脉血氧饱和度(SaO2)。2020年7月1日后入院的患者中，没有立即需要基于脉搏血氧饱和度(没有补充氧气的情况下SpO2水平达到94%或更高)进行新冠肺炎治疗的患者。自我报告的种族和民族，10分钟内并发SaO2和脉搏血氧饱和度(SpO2)之间的差异，以及最初未意识到需要进行新冠肺炎治疗(首次SaO2低于94%，尽管SpO2水平高于94%)。使用线性混合效应模型确定种族和民族与脉搏血氧饱和度测量误差程度(SpO2、 − 、SaO2)和未意识到需要新冠肺炎治疗的几率的关联。使用混合效应模型评估了最初未认识到的治疗需求与接受治疗的时间(雷米替韦或地塞米松)、住院死亡率、30天再住院时间和住院时间之间的关系。所有模型都考虑了人口统计学、临床特征和医院地点。使用交互作用术语评估种族和民族的影响修改。在24例同时进行血氧饱和度和血氧饱和度测定的 患者中(平均年龄63.9[15.8]岁；10例 263例女性[41.9%]；3,922黑人[16.0%]，7,895西班牙裔[32.2%]，2,554亚裔、美国原住民或阿拉斯加原住民、夏威夷人或太平洋岛民，或其他种族或民族[10.4%]，10 133白人[41.4%])，脉搏血氧仪高估了黑人(调整后的平均差异，0.93[95%CI，0.74-1.12]个百分点)，西班牙裔(0.49[95%CI，0.34-0.63]个百分点)，以及其他(0.53[95%CI，0.34-0.63个百分点，0.35-0.72]个百分点)与白人患者相比。在8635名同时患有SpO2和 − 血氧饱和度但不立即需要新冠肺炎治疗的患者中，与白人患者相比，黑人患者的脉搏血氧饱和度显著更有可能掩盖了新冠肺炎治疗的适应症(调整后的优势比[AOR]，1.65；95%CI，1.33-2.03)。没有意识到需要新冠肺炎治疗的患者接受新冠肺炎治疗的可能性降低10%(调整后的风险比为0.9；95%可信区间为0.83-0.97)，再入院的几率更高(调整后的风险比为2.41；95%可信区间为1.39-4.18)，与种族无关(交互作用 = 为0.45，P = 为0.14)。住院死亡率(AOR，0.84；95%CI，0.71~1.01)或住院时间(平均差异，−为1.4d；95%CI，−为3.1d~0.2d)与未认识到的新冠肺炎治疗需求无关。在这项队列研究中，脉搏血氧仪对血氧饱和度的高估导致新冠肺炎疗法延迟实施，无论种族如何，再次入院的可能性都更高。黑人患者更有可能有未被认识到的治疗需求，这可能会对人群水平的健康差距产生影响。
Is overestimation of oxygen saturation by pulse oximeters associated with delayed delivery of COVID-19 specific therapies, hospital readmission, length of stay, or in-hospital mortality, and are associations different by race and ethnicity? In this cohort study of 24 504 patients with concurrently measured pulse oximetry and arterial oxygen saturation, pulse oximeters more commonly overestimated arterial oxygen saturation in patients from minority racial and ethnic groups and led to delayed recognition of need for COVID-19 therapy among Black patients compared with White patients. In a subset of 8635 patients without immediate need for COVID-19 therapy on admission, overestimation of oxygen saturation by pulse oximetry was associated with delayed delivery of COVID-19 therapy and increased risk of hospital readmission, irrespective of patient race. These results suggest that although racial and ethnic disparities exist in measurement of oxygen saturation by pulse oximetry, overestimation may increase the risk of hospital readmission regardless of patient race. This cohort study of US adults treated at acute care facilities for COVID-19 examines the association of overestimation of oxygen saturation by pulse oximetry and clinical outcomes stratified by race and ethnicity. Many pulse oximeters have been shown to overestimate oxygen saturation in persons of color, and this phenomenon has potential clinical implications. The relationship between overestimation of oxygen saturation with timing of COVID-19 medication delivery and clinical outcomes remains unknown. To investigate the association between overestimation of oxygen saturation by pulse oximetry and delay in administration of COVID-19 therapy, hospital length of stay, risk of hospital readmission, and in-hospital mortality. This cohort study included patients hospitalized for COVID-19 at 186 acute care facilities in the US with at least 1 functional arterial oxygen saturation (SaO2) measurement between March 2020 and October 2021. A subset of patients were admitted after July 1, 2020, without immediate need for COVID-19 therapy based on pulse oximeter saturation (SpO2 levels of 94% or higher without supplemental oxygen). Self-reported race and ethnicity, difference between concurrent SaO2 and pulse oximeter saturation (SpO2) within 10 minutes, and initially unrecognized need for COVID-19 therapy (first SaO2 reading below 94% despite SpO2 levels of 94% or above). The association of race and ethnicity with degree of pulse oximeter measurement error (SpO2 − SaO2) and odds of unrecognized need for COVID-19 therapy were determined using linear mixed-effects models. Associations of initially unrecognized need for treatment with time to receipt of therapy (remdesivir or dexamethasone), in-hospital mortality, 30-day hospital readmission, and length of stay were evaluated using mixed-effects models. All models accounted for demographics, clinical characteristics, and hospital site. Effect modification by race and ethnicity was evaluated using interaction terms. Among 24 504 patients with concurrent SpO2 and SaO2 measurements (mean [SD] age, 63.9 [15.8] years; 10 263 female [41.9%]; 3922 Black [16.0%], 7895 Hispanic [32.2%], 2554 Asian, Native American or Alaskan Native, Hawaiian or Pacific Islander, or another race or ethnicity [10.4%], and 10 133 White [41.4%]), pulse oximetry overestimated SaO2 for Black (adjusted mean difference, 0.93 [95% CI, 0.74-1.12] percentage points), Hispanic (0.49 [95% CI, 0.34-0.63] percentage points), and other (0.53 [95% CI, 0.35-0.72] percentage points) patients compared with White patients. In a subset of 8635 patients with a concurrent SpO2 − SaO2 pair without immediate need for COVID-19 therapy, Black patients were significantly more likely to have pulse oximetry values that masked an indication for COVID-19 therapy compared with White patients (adjusted odds ratio [aOR], 1.65; 95% CI, 1.33-2.03). Patients with an unrecognized need for COVID-19 therapy were 10% less likely to receive COVID-19 therapy (adjusted hazard ratio, 0.90; 95% CI, 0.83-0.97) and higher odds of readmission (aOR, 2.41; 95% CI, 1.39-4.18) regardless of race (P for interaction = .45 and P = .14, respectively). There was no association of unrecognized need for COVID-19 therapy with in-hospital mortality (aOR, 0.84; 95% CI, 0.71-1.01) or length of stay (mean difference, −1.4 days; 95% CI, −3.1 to 0.2 days). In this cohort study, overestimation of oxygen saturation by pulse oximetry led to delayed delivery of COVID-19 therapy and higher probability of readmission regardless of race. Black patients were more likely to have unrecognized need for therapy with potential implications for population-level health disparities.
影响因子：
2.8
作者：
Muzammil, Taimur Sohail;Gangu, Karthik;Nasrullah, Adeel;Majeed, Harris;Chourasia, Prabal;Bobba, Aneish;Shekhar, Rahul;Bartlett, Christopher;Sheikh, Abu Baker
通讯作者：
Sheikh, Abu Baker