Background Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute Covid-19. Main research questions What exercise tests have been used to assess exertional hypoxia at home or in an ambulatory setting in the context of Covid-19 and to what extent have they been validated? What exercise tests have been used to assess exertional hypoxia in other lung conditions, to what extent have they been validated and what is the applicability of these studies to acute Covid-19? Method AMED, CINAHL, EMBASE MEDLINE, Cochrane and PubMed using LitCovid, Scholar and Google databases were searched to September 2020. Studies where participants had Covid-19 or another lung disease and underwent any form of exercise test which was compared to a reference standard were eligible. Risk of bias was assessed using QUADAS 2. A protocol for the review was published on the Medrxiv database. Results Of 47 relevant papers, 15 were empirical studies, of which 11 described an attempt to validate one or more exercise desaturation tests in lung diseases other than Covid-19. In all but one of these, methodological quality was poor or impossible to fully assess. None had been designed as a formal validation study (most used simple tests of correlation). Only one validation study (comparing a 1-min sit-to-stand test [1MSTST] with reference to the 6-min walk test [6MWT] in 107 patients with interstitial lung disease) contained sufficient raw data for us to calculate the sensitivity (88%), specificity (81%) and positive and negative predictive value (79% and 89% respectively) of the 1MSTST. The other 4 empirical studies included two predictive studies on patients with Covid-19, and two on HIV-positive patients with suspected pneumocystis pneumonia. We found no studies on the 40-step walk test (a less demanding test that is widely used in clinical practice to assess Covid-19 patients). Heterogeneity of study design precluded meta-analysis. Discussion Exertional desaturation tests have not yet been validated in patients with (or suspected of having) Covid-19. A stronger evidence base exists for the diagnostic accuracy of the 1MSTST in chronic long-term pulmonary disease; the relative intensity of this test may raise safety concerns in remote consultations or unstable patients. The less strenuous 40-step walk test should be urgently evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s13643-021-01620-w.
【저자키워드】 COVID-19, Desaturation, 1-min sit-to-stand test, 6-min walk test, 40-step test, Normoxia, Silent hypoxia, Hidden hypoxia, 【초록키워드】 Meta-analysis, protocol, hypoxia, Pneumonia, pulse oximetry, diagnostic, lung, Lung disease, Interstitial lung disease, database, heterogeneity, Predictive value, sensitivity, specificity, Diagnostic accuracy, Rapid test, Accuracy, Desaturation, Lung diseases, Patient, Study design, correlation, patients, Guidance, reference standard, COVID-19 patients, Clinical practice, Rapid tests, pulmonary disease, Evidence, Methodological quality, Negative predictive value, Google, Predictive, Formal, intensity, supplementary material, CINAHL, participant, raw data, validation study, AMED, acute COVID-19, applicability, positive, exertion, Research question, raise, Result, described, the patient, evaluated, less, searched, conditions, calculate, eligible, precluded, Scholar, 【제목키워드】 systematic review, Efficacy and safety, Evidence, Direct,