title: Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial.
abstract: OBJECTIVE
  Routine use of pulse oximetry has been associated with changes in bronchiolitis management and may have lowered the hospitalization threshold for patients with bronchiolitis.
  
  
  OBJECTIVE
  To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed.
  
  
  METHODS
  Randomized, double-blind, parallel-group trial conducted from 2008 to 2013 in a tertiary-care pediatric emergency department in Toronto, Ontario, Canada. Participants were 213 otherwise healthy infants aged 4 weeks to 12 months with mild to moderate bronchiolitis and true oxygen saturations of 88% or higher.
  
  
  METHODS
  Pulse oximetry measurements with true saturation values displayed or with altered saturation values displayed that have been increased 3 percentage points above true values.
  
  
  METHODS
  The primary outcome was hospitalization within 72 hours, defined as inpatient admission within this interval or active hospital care for greater than 6 hours. Secondary outcomes included the use of supplemental oxygen in the emergency department, level of physician agreement with discharge from the emergency department, length of emergency department stay, and unscheduled visits for bronchiolitis within 72 hours.
  
  
  RESULTS
  Forty-four of 108 patients (41%) in the true oximetry group and 26 of 105 (25%) in the altered oximetry group were hospitalized within 72 hours (difference, 16% [95% CI for the difference, 3.6% to 28.4%]; P = .005). Using the emergency department physician as a random effect, the primary treatment effect remained significant (adjusted odds ratio, 4.0 [95% CI, 1.6 to 10.5]; P = .009). None of the secondary outcomes were significantly different between the groups. There were 23 of 108 (21.3%) subsequent unscheduled medical visits for bronchiolitis in the true oximetry group and 15 of 105 (14.3%) in the altered oximetry group (difference, 7% [95% CI, -0.3% to 0.2%]; P = .18).
  
  
  CONCLUSIONS
  Among infants presenting to an emergency department with mild to moderate bronchiolitis, those with an artificially elevated pulse oximetry reading were less likely to be hospitalized within 72 hours or to receive active hospital care for more than 6 hours than those with unaltered oximetry readings. This suggests that oxygen saturation should not be the only factor in the decision to admit, and its use may need to be reevaluated.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00673946.
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
authors.affiliation: Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Freedman
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Coates
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Upton
authors.initials: U
authors.lastname: Allen
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Ungar
authors.affiliation: Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Zelia
authors.initials: Z
authors.lastname: DaSilva
authors.affiliation: Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Willan
mesh_terms: D001988:Bronchiolitis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003657:Decision Making; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010092:Oximetry / Q000592:standards*; D010100:Oxygen / Q000032:analysis; D010102:Oxygen Inhalation Therapy; D010343:Patient Admission / Q000706:statistics & numerical data; D015203:Reproducibility of Results
chemical_list: D010100:Oxygen