title: Does pulse oximeter use impact health outcomes? A systematic review.
abstract: OBJECTIVE
  Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used?
  
  
  METHODS
  Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references.
  
  
  METHODS
  Children 0-19 years presenting for the first time to hospitals, emergency departments or primary care facilities.
  
  
  METHODS
  Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used.
  
  
  METHODS
  mortality, morbidity, length of stay, and treatment and management changes.
  
  
  RESULTS
  The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians' decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation.
  
  
  CONCLUSIONS
  As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes.
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Abigail J
authors.identifier: http://orcid.org/0000-0002-3183-0010
authors.initials: AJ
authors.lastname: Enoch
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Sasha
authors.initials: S
authors.lastname: Shepperd
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D010092:Oximetry / Q000401:mortality* / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Evidence Based Medicine; Health services research; Outcomes research; Paediatric Practice; Respiratory