CONTRIBUTION OF ROUTINE PULSE OXIMETRY TO EVALUATION AND MANAGEMENT OF PATIENTS WITH RESPIRATORY ILLNESS IN A PEDIATRIC EMERGENCY DEPARTMENT

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.