Evidence map›Paper›PMID 37278775›Full record

ArticleThe western journal of emergency medicine2023

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.

Onlak Ruangsomboon, Supawich Jirathanavichai, Nutthida Phanprasert, Chanokporn Puchongmart, Phetsinee Boonmee, Netiporn Thirawattanasoot, Thawonrat Dorongthom, Apichaya Monsomboon, Nattakarn Praphruetkit

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The western 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 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Observational
  2. Validation of SpOAdvances in respiratory medicine · 2026
    Article
  3. Review
  4. Non-invasive SpO2/FiO2 ratio (SFR) as surrogate for PaO2/FiO2 ratio (PFR): A scoping review.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2025
    Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Onlak RuangsomboonMahidol University, Siriraj Hospital, Department of Emergency Medicine, Bangkok, Thailand.
Supawich JirathanavichaiMahidol University, Siriraj Hospital, Department of Emergency Medicine, Bangkok, Thailand.
Nutthida PhanprasertMahidol University, Siriraj Hospital, Department of Emergency Medicine, Bangkok, Thailand.
Chanokporn PuchongmartBanphaeo General Hospital, Department of Emergency Medicine, Samutsakhon, Thailand.
Phetsinee BoonmeeRatchaburi Hospital, Department of Emergency Medicine, Ratchaburi, Thailand.
Netiporn ThirawattanasootBuddhachinaraj Phitsanulok Hospital, Department of Emergency Medicine and Forensic Medicine, Phitsanulok, Thailand.
Thawonrat DorongthomPrachuap Khiri Khan Hospital, Department of Emergency Medicine and Forensic Medicine, Prachuap Khiri Khan, Thailand.
Apichaya MonsomboonMahidol University, Siriraj Hospital, Department of Emergency Medicine, Bangkok, Thailand.
Nattakarn PraphruetkitMahidol University, Siriraj Hospital, Department of Emergency Medicine, Bangkok, Thailand.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionHigh-flow nasal cannula (HFNC) is a respiratory support measure for coronavirus 2019 (COVID-19) patients that has been increasingly used in the emergency department (ED). Although the respiratory rate oxygenation (ROX) index can predict HFNC success, its utility in emergency COVID-19 patients has not been well-established. Also, no studies have compared it to its simpler component, the oxygen saturation to fraction of inspired oxygen (SpO2/FiO2 [SF]) ratio, or its modified version incorporating heart rate. Therefore, we aimed to compare the utility of the SF ratio, the ROX index (SF ratio/respiratory rate), and the modified ROX index (ROX index/heart rate) in predicting HFNC success in emergency COVID-19 patients.

methodsWe conducted this multicenter retrospective study at five EDs in Thailand between January-December 2021. Adult patients with COVID-19 treated with HFNC in the ED were included. The three study parameters were recorded at 0 and 2 hours. The primary outcome was HFNC success, defined as no requirement of mechanical ventilation at HFNC termination.

resultsA total of 173 patients were recruited; 55 (31.8%) had successful treatment. The two-hour SF ratio yielded the highest discrimination capacity (AUROC 0.651, 95% CI 0.558-0.744), followed by two-hour ROX and modified ROX indices (AUROC 0.612 and 0.606, respectively). The two-hour SF ratio also had the best calibration and overall model performance. At its optimal cut-point of 128.19, it gave a balanced sensitivity (65.3%) and specificity (61.8%). The two-hour SF≥128.19 was also significantly and independently associated with HFNC failure (adjusted odds ratio 0.29, 95% CI 0.13-0.65; P=0.003).

conclusionThe SF ratio predicted HFNC success better than the ROX and modified ROX indices in ED patients with COVID-19. With its simplicity and efficiency, it may be the appropriate tool to guide management and ED disposition for COVID-19 patients receiving HFNC in the ED.

Indexed as

COVID-19Respiratory InsufficiencyAdultCannulaHumansOxygenOxygen Inhalation TherapyOxygen SaturationRespiratory RateRetrospective StudiesOxygen

Identifiers

PMID37278775
PMCPMC10284520

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.