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Summary Background Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. Aims This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units than individuals with White skin. Methods Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with Covid-19 infection to intensive care units were assessed, and how this varied by ethnic group. Results Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to intensive care units (Kruskal Wallis test, p = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal Wallis test, p = 0.005). There were significant differences in mean respiratory rates in these patients (p < 0.0001), ranging from 26 breaths/minute in individuals with White ethnicity to 30 breaths/minute for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. Conclusions These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia, and may contribute to differences in health outcomes across ethnic groups globally.

Research question: Should prognostic tools for SARS-CoV-2 use parameters fitted only at time of admission or across all time points of an admission?Methods: A cohort study used clinical data to model the dynamic change in prognosis of SARS-CoV-2 in a single hospital in England including all patients admitted from 1st February 2020 until 31st December 2020, and then followed up for ICU admission, death, or discharge from hospital for 60 days. We incorporated clinical observations and blood tests into two-time varying Cox proportional hazards models predicting daily 24–48-hour risk of admission to ICU for those eligible, or death for those ineligible for escalation.Results: To develop the model 491 patients were eligible for ICU escalation and 769 were ineligible for escalation. Our model had good discrimination of daily risk of ICU admission in the validation cohort (n = 1141, C statistic = 0.91 (95% CI 0.89 -0.94)) and performed better than other scores (NEWS2, ISCARIC 4C) calculated using only parameters on admission, but overestimated escalation (calibration slope 0.7). Conclusions: A bespoke daily SARS-CoV-2 escalation risk prediction score can predict need for clinical escalation better than a generic early warning score or a single estimation of risk calculated at admission.

Aim: To determine the excess of acute medical contacts following a day-case diagnostic gastroscopy. Methods: Cohort study using English linked primary, secondary care and death registry electronic health data. We included 277,535 diagnostic day-case gastroscopies in 225,304 people between 1998 and 2016 and followed up for 30 days. 1,383,535 30-day periods without a gastroscopy within 991,249 people frequency matched on year, gender and decade of birth. Non-cancer deaths, emergency non-cancer admissions and cardio, vascular or respiratory (CVR) primary care consultations were identified and adjusted for each other as competing risks. Outcomes related to possible indications for gastroscopy were censored. Results: 5.1% of day-case diagnostic gastroscopies were followed by emergency hospital admission, 0.4% for a CVR diagnosis. Adjusted for age, sex, morbidity, time trends, indications and competing risks, there was a 0.1% excess of CVR-related hospital admissions compared to controls. This reduced to 0.05% (95% confidence interval 0.04–0.06%) in people under 40 years without morbidity and increased to 1.1% (0.6%–1.6%) in people over 90 years with high comorbidity. Similarly, by 30 days, 3.8% had a primary care consultation for a CVR problem, with an excess after adjustment ranging from 0.13% (0.11%–0.16%) to 0.31% (0.14%–0.50%). Overall numbers needed to harm ranged from 1 in 294 gastroscopies to 1 in 67 gastroscopies. Conclusions: There was an excess of vascular and respiratory events associated with a diagnostic gastroscopy. In younger patients, this risk manifested as an increase in primary care consultations while in older patients there was an increase in emergency hospital admissions.

Background and Aims: There is evidence that several inflammatory diseases are associated with increased cardiovascular risk. Whether this is true for inflammatory bowel diseases remains controversial. We aimed to assess this risk corrected for the effects of conventional vascular risk factors, and IBD disease activity.Methods: We conducted a cohort study in British general practice and hospital records from the Clinical Practice Research Datalink. We extracted the records of subjects with IBD and matched controls from 1997 to 2017. We conducted Cox proportional hazards and self-controlled case series analyses to examine the associations of IBD, disease activity and hospitalisation with the risk of myocardial infarction, stroke and cardiovascular death in a manner attempting to remove the effect of likely confounders.Results: We identified 31,175 IBD patients (16,779 UC, 10,721 Crohn’s disease and 3,675 unclassifiable cases) and 154,412 matched controls. 532 myocardial infarctions, 555 strokes and 469 cardiovascular deaths were observed in IBD cases. Our Cox regression models adjusted for potential confounders, showed no significant excess of vascular events for IBD patients overall. There was however an increased hazard of MI in ambulatory patients for acute disease (Hazard Ration 1.83 (1.28-2.62)) and chronic activity (Hazard Ratio 1.69 (1.24-2.30)). This effect of disease activity was confirmed in our case series analysis.Conclusions:Though we have found no evidence of an overall excess of vascular events in IBD patients, our findings of increased risk with more active disease suggest the potential for anti-inflammatory therapies to reduce cardiovascular risk in this patient group.