Patients ‘must be sent to hospital earlier’

COVID patients should be sent to hospital earlier, researchers have said after finding that just a small drop in blood oxygen levels can indicate an increased risk of dying.

A paper published by UK academics and led by the NHS’S national clinical lead for patient deterioration found that current NHS guidelines on when to send someone to hospital based on their blood oxygen levels may be set too high.

The NHS considers blood oxygen levels of between 94 and 98 per cent as “normal” for treatment at home but the study, which compared oxygen readings taken by ambulance crews with outcomes, found that even small falls in readings below 96 per cent should ring alarm bells.

The study, which is yet to be peerreviewed, says: “Even relatively small decreases in oxygen saturation are markers of increased risk of death and suggest that a lower threshold for hospital conveyance may be necessary for patients who traditionally would be considered to have only minor physiological derangement and otherwise have been left at home”.

In most cases of pneumonia, blood oxygen levels start to fall after patients develop symptoms. Doctors have therefore become used to focusing their attention on a patient’s symptoms, especially signs of laboured breathing.

But with Covid-19 it is not uncommon for blood oxygen levels to fall even before a patient develops obvious breathing difficulties. In the early stages of the pandemic, this was not realised and many patients are thought to have been taken to hospital too late.

The study says: “We found that even small deflections in oxygen saturations of 1-2 per cent below 96 per cent confer an increased mortality risk, say the authors.

“Even patients with presenting oxygen saturations of 94-95 per cent, val

‘Even relatively small decreases in oxygen saturation are markers of increased risk of death’

ues regarded as within this normal range, had a significantly higher 30-day mortality rate (5.3 per cent) than those presenting with oxygen saturations higher than 95 per cent (2.3 per cent).

The new study suggests more lives may be saved if guidelines are tightened further.

Trisha Greenhalgh, professor of primary care at the University of Oxford, described the study’s findings as “important” and urged everyone to get an oximeter at home.

“Just like you have a thermometer at home, every family should have an oximeter as part and parcel of first aid kit,” she said.