title: Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment.
abstract: BACKGROUND
  The pulmonary embolism severity index (PESI) or simplified version (sPESI) are widely validated risk scores for the identification of eligible patients for outpatient treatment. Saturation is one of these criteria. For this metric, saturation of 90% or greater is assigned zero points. However, 90% saturation does not always exclude hypoxemic respiratory failure.
  
  
  OBJECTIVE
  The aims of this study were first was to define corresponding partial arterial oxygen pressure (PaO2) values according to saturation in pulmonary embolism (PE) patients, and the second was to define a target saturation that can exclude hypoxemic respiratory failure and enable secure discharge of PE patients from emergency departments.
  
  
  METHODS
  This is a retrospective study. To determine the optimal saturation value by which to detect hypoxemic respiratory failure, we generated receiver operating characteristic (ROC) curves and calculated the negative predictive value.
  
  
  RESULTS
  Total of 65 patients were included in this study. Mean PaO2levels from SaO289% to SaO293% were 52.8, 57.1, 57.3, 61, and 63.8 mmHg, respectively. ROC curve analysis revealed SaO2level of 91.5% to be optimal target saturation for excluding respiratory failure with 84.6% specificity and 89.7% sensitivity; area under the curve was 0.885 (95% CI 0.796-0.975). The negative predictive value was 80% for SaO2level of 92%.
  
  
  CONCLUSIONS
  Patients with PE may be in respiratory failure despite an oxyhemoglobin saturation of ≥90%. Although saturation is likely more important than precise PaO2in tissue oxygenation, clinicians should be aware of the physiological effects of hypoxemia and take this into account before making outpatient treatment decisions.
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Erol
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Aslıhan
authors.initials: A
authors.lastname: Gürün Kaya
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Arslan Ciftçi
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Çiledağ
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Şen
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Akın
authors.initials: A
authors.lastname: Kaya
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Çelik
authors.affiliation: Pulmonary Diseases Department, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Savaş
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D019540:Area Under Curve; D000066491:Clinical Decision-Making / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D018579:Patient Selection; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D012372:ROC Curve; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D010100:Oxygen
keywords: arterial oxygen saturation; hypoxemic respiratory failure; pulmonary embolism; simplified pulmonary embolism severity index