Aj. Maneker et al., CONTRIBUTION OF ROUTINE PULSE OXIMETRY TO EVALUATION AND MANAGEMENT OF PATIENTS WITH RESPIRATORY ILLNESS IN A PEDIATRIC EMERGENCY DEPARTMENT, Annals of emergency medicine, 25(1), 1995, pp. 36-40
Study objective: To determine whether routine pulse oximetry in a pedi
atric 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 evalua
tion by physicians with subsequent pulse oximetry readings. Setting: P
ediatric ED in an urban, university medical center. Participants: A co
nvenience sample of 368 patients presenting to the pediatric ED with r
espiratory illnesses. Methods: The history, physical examination, pedi
atric ED management, and therapy were recorded. Based on clinical asse
ssment, the physician was asked whether the patient had a low Sao2 (le
ss-than-or-equal-to 92%). Room-air pulse oximetry was then obtained, w
ith subsequent treatment and management plans recorded. Results: Clini
cal assessment had a sensitivity of 33%, specificity of 86%, negative
predictive value of 85%, and positive predictive value of 35% for dete
cting children with low Sao2. Unexpected low Sao2 usually led to a cha
nge in patient management or disposition. Conclusion: Clinical evaluat
ion 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.