July 1997

Pulse oximetry as a fifth pediatric vital sign.

Mower WR, Sachs C, Nicklin EL, Baraff LJ.

Pediatrics 1997; 99: 681-686.

Commentary by Charles Coté,


[ see abstract below ]

Mower and colleagues examined the utility of pulse oximetry for triage of pediatric patients presenting to a University based emergency room practice. Patients who bypassed triage or who were in need of immediate attention were excluded. This study was cleverly designed because prior to discharge from the facility, the physicians had to fill in a questionnaire in order to receive the proper discharge forms. They then received the screening pulse oximetry value and were then given the option to order further tests or therapies, and were allowed to alter their diagnosis.

Of the 2,327 patients with oximetry values obtained, 305 children had values less than 95% resulting in 81 additional diagnostic tests and 22 additional therapies. These tests varied from chest x-rays to ventilation perfusion scans. Twenty-five children (8.2%) had their diagnosis changed because of the information and additional testing resulting from pulse oximetry.

Of most interest is the fact that only 23 of the 73 patients with saturation values had tachypnea; approximately 67 percent of these patients were admitted for further treatment or evaluation. The findings of this study confirm in a different venue (not the operating room) that hypoxemia is not very well detected by physicians, particularly when it is borderline hypoxemia. This study also demonstrates that borderline hypoxemia does not result in tachypnea in most pediatric patients.

What is of importance here for the anesthesiologist is the fact that the most common diagnosis in children with saturations of < 95 percent was upper respiratory tract infection (N = 44). After finding out the results of pulse oximetry, an additional 6 patients were labeled as having an upper respiratory tract infection.

Two additional patients were diagnosed with pneumonia and one patient was diagnosed with bronchitis. This means that skilled pediatricians were unable to make these diagnoses on the basis of history and physical examination alone. The take home lesson here is that a baseline oxygen saturation would be a very reasonable and likely cost effective test to perform as part of the admission process, particularly for children with a current or recent upper respiratory tract infection. If pediatricians miss these important diagnoses how many do we miss as anesthesiologists?

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ABSTRACT