title: Accuracy of pulse oximetry in children.
abstract: OBJECTIVE
  For children with cyanotic congenital heart disease or acute hypoxemic respiratory failure, providers frequently make decisions based on pulse oximetry, in the absence of an arterial blood gas. The study objective was to measure the accuracy of pulse oximetry in the saturations from pulse oximetry (SpO2) range of 65% to 97%.
  
  
  METHODS
  This institutional review board-approved prospective, multicenter observational study in 5 PICUs included 225 mechanically ventilated children with an arterial catheter. With each arterial blood gas sample, SpO2 from pulse oximetry and arterial oxygen saturations from CO-oximetry (SaO2) were simultaneously obtained if the SpO2 was ≤ 97%.
  
  
  RESULTS
  The lowest SpO2 obtained in the study was 65%. In the range of SpO2 65% to 97%, 1980 simultaneous values for SpO2 and SaO2 were obtained. The bias (SpO2 - SaO2) varied through the range of SpO2 values. The bias was greatest in the SpO2 range 81% to 85% (336 samples, median 6%, mean 6.6%, accuracy root mean squared 9.1%). SpO2 measurements were close to SaO2 in the SpO2 range 91% to 97% (901 samples, median 1%, mean 1.5%, accuracy root mean squared 4.2%).
  
  
  CONCLUSIONS
  Previous studies on pulse oximeter accuracy in children present a single number for bias. This study identified that the accuracy of pulse oximetry varies significantly as a function of the SpO2 range. Saturations measured by pulse oximetry on average overestimate SaO2 from CO-oximetry in the SpO2 range of 76% to 90%. Better pulse oximetry algorithms are needed for accurate assessment of children with saturations in the hypoxemic range.
authors.affiliation: Department of Anesthesiology Critical Care Medicine, 4650 Sunset Blvd Mailstop 12, Children's Hospital Los Angeles, Los Angeles, CA 90027. pross@chla.usc.edu.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Ross
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Newth
authors.forename: Robinder G
authors.initials: RG
authors.lastname: Khemani
mesh_terms: D000293:Adolescent; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010092:Oximetry / Q000295:instrumentation / Q000592:standards* / Q000706:statistics & numerical data; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: congenital heart disease/defects; heart defects; hypoxia; mechanical ventilation; oximetry; pediatric