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 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.