ArticleInternational journal of emergency medicine2023
ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study.
Article in International journal of emergency medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Machine learning-based prediction models for noninvasive respiratory support failure in acute respiratory failure: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- Prediction of high-flow nasal cannula failure in patients with sepsis by a preliminary risk stratification model based on the ROX index.BMC infectious diseases · 2026Article
- Development of a predictive model for high-flow nasal cannula treatment failure in emergency department patients with acute heart failure: a retrospective secondary data analysis.Journal of Korean biological nursing science · 2026Article
- Prediction of high-flow nasal cannula failure in critically ill patients: a narrative review.Journal of intensive care · 2026Review
- Early Prediction of High-flow Nasal Cannula Failure Using Pediatric-modified HACOR Score in Children with Acute Hypoxemic Respiratory Distress: A Prospective Observational Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Review
- Monitoring patients with acute respiratory failure during non-invasive respiratory support to minimize harm and identify treatment failure.Critical care (London, England) · 2025Review
- Machine learning models compared with current clinical indices to predict the outcome of high flow nasal cannula therapy in acute hypoxemic respiratory failure.Critical care (London, England) · 2025Article
- The role of the AVAPS ventilation mode combined with TCM monitoring in weaning patients with AECOPD.Scientific reports · 2025Article
- Performance of A-DROP, NEWS2, and REMS in predicting in-hospital mortality and mechanical ventilation in pneumonia patients in the emergency department: a retrospective cohort study.International journal of emergency medicine · 2024Article
- Ratio of Oxygen Saturation to Inspired Oxygen, ROX Index, Modified ROX Index to Predict High Flow Cannula Success in COVID-19 Patients: Multicenter Validation Study.The western journal of emergency medicine · 2023Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHigh-flow nasal cannula has been a promising initial respiratory support measure for patients with acute hypoxemic respiratory failure (AHRF) in the emergency department (ED). However, delayed detection of HFNC failure is associated with increased mortality. The ROX index is a tool that can help predict HFNC success. Nonetheless, its utility in ED patients is limited, and no studies have compared it with the HACOR scale, another tool that may be as accurate in predicting HFNC failure. Therefore, we aimed to compare the prognostic utility of the ROX index and the HACOR scale in emergency AHRF patients.
methodsThis prospective observational study was conducted at the ED of Siriraj Hospital, Thailand, between August 2018 and February 2020. Adult patients with AHRF requiring HFNC in the ED were included. The ROX index and the HACOR scale were measured at 1, 2, and 6 h after HFNC initiation. The primary outcome was HFNC success, defined as no intolerance or escalation towards mechanical ventilation or non-invasive ventilation within 48 h.
resultsA total of 75 patients were enrolled; 52 (69.3%) had a successful treatment. The ROX index was higher in the success group, while the HACOR scale was lower at all timepoints. The ROX index yielded generally higher discrimination capacity based on the area under the receiver operating characteristic curve (AUROC) than the HACOR scale [AUROC at 1, 2, and 6 h = 0.815, 0.784, 0.853 for ROX in predicting HFNC success and 0.733, 0.690, and 0.764 for HACOR in predicting HFNC failure]. The ROX index measured at 6 h at the cut-point of 4.88 had 92.98% sensitivity, 61.11% specificity, 88.33% positive predictive value, and 73.33% negative predictive value with a diagnostic accuracy of 85.33%.
conclusionThe ROX index had superior prognostic utility in predicting HFNC outcome (success/failure) compared to the HACOR scale in patients with AHRF in the ED setting. Moreover, it is less complex and more efficient to be employed at bedside. Therefore, the ROX index is a more appropriate tool to guide further management and potential escalation therapy for AHRF patients with HFNC therapy initiated in the ED.
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