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(≤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. [Maneker AJ, Petrack EM, Krug SE: Contribution of routine pulse oximetry to evaluation and management of patients with respiratory illness in a pediatric emergency department. Ann Emerg Med January 1995;25:36-40.].