Pulse oximetry as a fifth pediatric vital sign.
OBJECTIVE
To determine the utility of pulse oximetry as a routine fifth vital sign in acute pediatric assessment.


METHODS
Prospective study using pulse oximetry to measure oxygen saturation in children presenting to emergency department triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to discharge or admit each child. We measured changes in medical treatment and diagnoses initiated after the disclosure of pulse oximetry values.


METHODS
The study included 2127 consecutive children presenting to triage at a university emergency department.


METHODS
Changes in select diagnostic tests: chest radiography, complete blood count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonists, supplemental oxygen; and hospital admission and final diagnoses that occurred after disclosure of triage pulse oximetry values.


RESULTS
Of 305 children having triage pulse oximetry values less than 95%, physicians ordered second oximetry for 49, additional chest radiography for 16, complete blood counts for 7, arterial blood gas measurements for 4, spirometry for 2, and ventilation-perfusion scans for 2. Physicians ordered 39 new therapies for 33 patients, including antibiotics for 15, supplemental oxygen for 11, and beta-agonists for 8. Five patients initially scheduled for hospital discharge were subsequently admitted. Physicians changed or added diagnoses in 25 patients.


CONCLUSIONS
Using pulse oximetry as a routine fifth vital sign resulted in important changes in the treatment of a small proportion of pediatric patients.
Mower
W R
WR
UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles, California 90024, USA.
Sachs
C
C
Nicklin
E L
EL
Baraff
L J
LJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D012119:Respiration; D014218:Triage / Q000379:methods*
D010100:Oxygen