Novel use of home pulse oximetry monitoring in COVID‐19 patients discharged from the emergency department identifies need for hospitalization

Shah, Sonia; Majmudar, Kaushal; Stein, Amy; Gupta, Nita; Suppes, Spencer; Karamanis, Marina; Capannari, Joseph; Sethi, Sanjay; Patte, Christine

OBJECTIVES: Our objective was to evaluate patient‐reported oxygen saturation (SpO(2)) using pulse oximetry as a home monitoring tool for patients with initially non‐severe COVID‐19 to identify need for hospitalization. METHODS: Patients were enrolled at the emergency department (ED) and outpatient testing centers. Each patient was given a home pulse oximeter and instructed to record their SpO(2) every eight hours. Patients were instructed to return to the ED for sustained home SpO(2) <92% or if they felt they needed emergent medical attention. Relative risk was used to assess the relation between hospitalization and home SpO(2) <92% in COVID‐19 positive patients. RESULTS: We enrolled 209 patients with suspected COVID‐19, of which 77 patients tested positive for COVID‐19 and were included. Subsequent hospitalization occurred in 22/77 (29%) patients. Resting home SpO(2) <92% was associated with an increased likelihood of hospitalization compared to SpO(2) ≥92% [RR 7.0 (95% CI 3.4 – 14.5), p‐value <0.0001]. Home SpO2 <92% was also associated with increased risk of ICU admission, ARDS and septic shock. In our cohort, 50% of patients who ended up hospitalized only returned to the ED for incidental finding of low home SpO(2) without worsening of symptoms. One‐third (33%) of non‐hospitalized patients stated they would have returned to the ED if they did not have a pulse oximeter to reassure them at home. CONCLUSIONS: This study found that home pulse oximetry monitoring identifies need for hospitalization in initially non‐severe COVID‐19 patients when a cut off of SpO(2) 92% is used. Half of patients who ended up hospitalized had SpO(2) <92% without worsening symptoms. Home SpO(2) monitoring also reduces unnecessary ED revisits.