Soft tissue oxygen saturation to predict admission from the emergency department: A prospective observational study.
OBJECTIVE
We evaluated a soft tissue oxygen saturation (Sto2) measurement at triage for predicting admission to the hospital in adults presenting to the emergency department (ED) in addition to data routinely gathered at triage.


METHODS
This was a prospective, observational, single center study of adults presenting to the ED for evaluation. Research assistants obtained thenar eminence Sto2 measurements on subjects in ED triage. ED providers not involved in the study then made all management and disposition decisions. We prospectively collected data on each subject's final ED disposition (admission versus discharge). We identified the optimal Sto2 cutoff value for predicting admission. We then used logistic regression modeling to describe the added predictive value of Sto2 beyond routinely collected triage data including Emergency Severity Index level, age, and vital signs.


RESULTS
We analyzed 2588 adult (>17years) subjects with 743 subjects (28.7%) admitted to the hospital. Sto2<76% was the optimal diagnostic cutoff for predicting admission. Of subjects with Sto2<76%, 158 of 384 (41.1%) underwent admission versus 585 of 2204 (26.5%) subjects with Sto2≥76. After controlling for age, vital signs, and ESI level in the logistic regression analysis, Sto2<76% had an odds ratio of 1.54 (95% confidence interval (CI), 1.19 to 1.98) for predicting admission.


CONCLUSIONS
Sto2 may provide additional prognostic data to routine triage assessment regarding the disposition for undifferentiated adult patients presenting to the ED.
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States. Electronic address: william.t.davis294.mil@mail.mil.
William T
WT
Davis
Portia Statistical Consulting LLC, San Antonio, TX, United States.
Josh
J
Lospinso
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States.
Robert M
RM
Barnwell
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States.
John
J
Hughes
United States Army Institute of Surgical Research, San Antonio, TX, United States.
Steven G
SG
Schauer
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States.
Thomas B
TB
Smith
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States.
Michael D
MD
April
D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared; D014218:Triage / Q000379:methods*; D014481:United States
Hospital admission tests; Near-infrared; Soft tissue oximetry; Spectroscopy; Triage