Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
College of Health Care Professions Claudiana, Bolzano-Bozen, Italy.
J Adv Nurs. 2021 Aug;77(8):3361-3369. doi: 10.1111/jan.14848. Epub 2021 Apr 1.
To assess whether the application of a non-invasive tool, such as ratio of oxygen saturation (ROX) index, during triage can identify patients with COVID-19 at high risk of developing acute respiratory distress syndrome (ARDS).
A multi-centre, observational, retrospective study.
Only COVID-19 positive patients who required an emergency department evaluation for dyspnoea were considered. The primary objective of the study was to compare the ROX value obtained during triage with the medical diagnosis of ARDS and intubation in 72 h of the triage evaluation. The ROX index value was also compared with objective outcomes, such as the pressure of arterial O (PaO )/fraction of inspired oxygen (FiO ) ratio and the lung parenchyma volume involved in COVID-19-related inflammatory processes, based on 3D reconstructions of chest computed tomography (CT).
During the study period, from 20 March 2020 until 31 May 2020, a total of 273 patients with confirmed SARS-CoV-2 infection were enrolled. The predictive ability of ROX for the risk of developing ARDS in 72 h after triage evaluation was associated with an area under the receiver operating characteristic (AUROC) of 0.845 (0.797-0.892, p < 0.001), whereas the AUROC value was 0.727 (0.634-0.821, p < 0.001) for the risk of intubation. ROX values were strongly correlated with PaO /FiO values (r = 0.650, p < 0.001), decreased ROX values were associated with increased percentages of lung involvement based on 3D CT reconstruction (r = -0.371, p < 0.001).
The ROX index showed a good ability to identify triage patients at high evolutionary risk. Correlations with objective but more invasive indicators (PaO /FiO and CT) confirmed the important role of ROX in identifying COVID-19 patients with extensive pathological processes.
During the difficult triage evaluation of COVID-19 patients, the ROX index can help the nurse to identify the real severity of the patient. The triage systems could integrate the ROX in the rapid patient assessment to stratify patients more accurately.
评估在分诊过程中应用非侵入性工具（如氧饱和度比（ROX）指数）是否可以识别出 COVID-19 患者中发生急性呼吸窘迫综合征（ARDS）的高危患者。
多中心、观察性、回顾性研究。
仅考虑因呼吸困难而需要急诊科评估的 COVID-19 阳性患者。该研究的主要目的是比较分诊期间获得的 ROX 值与分诊评估 72 小时内的 ARDS 诊断和插管。还根据胸部 CT（CT）的 3D 重建，将 ROX 指数值与客观结果（如动脉氧分压（PaO ）/吸入氧分数（FiO ）比值和 COVID-19 相关炎症过程中涉及的肺实质体积）进行比较。
在研究期间，从 2020 年 3 月 20 日至 2020 年 5 月 31 日，共纳入了 273 名确诊 SARS-CoV-2 感染的患者。ROX 对分诊后 72 小时内发生 ARDS 的风险的预测能力与接受者操作特征（ROC）曲线下面积（AUROC）为 0.845（0.797-0.892，p<0.001）相关，而 AUROC 值为 0.727（0.634-0.821，p<0.001）为插管风险。ROX 值与 PaO /FiO 值呈强相关性（r=0.650，p<0.001），ROX 值降低与基于 3D CT 重建的肺受累百分比增加相关（r=-0.371，p<0.001）。
ROX 指数显示出识别高进化风险分诊患者的良好能力。与客观但更具侵袭性的指标（PaO /FiO 和 CT）的相关性证实了 ROX 在识别 COVID-19 患者广泛病理过程中的重要作用。
在 COVID-19 患者困难的分诊评估期间，ROX 指数可以帮助护士识别患者的真实严重程度。分诊系统可以将 ROX 纳入快速患者评估中，以更准确地对患者进行分层。
