Contribution of routine pulse oximetry to evaluation and management of patients with respiratory illness in a pediatric emergency department

Abstract

Study objective: To determine whether routine pulse oximetry in a pediatric emergency department can be used to identify patients with a low oxygen saturation (SaO2) that is unexpected on the basis of clinical evaluation.

Design: Prospective comparison of blinded, clinical evaluation by physicians with subsequent pulse oximetry readings.

Setting: Pediatric ED in an urban, university medical center.

Participants: A convenience sample of 368 patients presenting to the pediatric ED with respiratory illnesses.

Methods: The history, physical examination, pediatric ED management, and therapy were recorded. Based on clinical assessment, the physician was asked whether the patient had a low SaO2 (< or = 92%). Room-air pulse oximetry was then obtained, with subsequent treatment and management plans recorded.

Results: Clinical assessment had a sensitivity of 33%, specificity of 86%, negative predictive value of 85%, and positive predictive value of 35% for detecting children with low SaO2. Unexpected low SaO2 usually led to a change in patient management or disposition.

Conclusion: Clinical evaluation in a pediatric ED does not screen adequately for the detection of hypoxemia and should be supplemented by routine pulse oximetry in all patients with respiratory findings.