An evaluation of pulse oximetry in prehospital care

Ann Emerg Med. 1991 Aug;20(8):887-91. doi: 10.1016/s0196-0644(05)81432-5.


Study objectives: We performed this study to evaluate the accuracy of pulse oximetry oxygen saturation (SpO2) against direct measurements of arterial oxygen saturation (SaO2) in the field.

Design: Prospective, cross-sectional, paired measurements of SpO2 against SaO2.

Setting: This evaluation was done in the prehospital setting.

Interventions: A pulse oximeter with digital probe was used to measure SpO2 in 30 patients. Arterial blood gases were drawn in the field while the pulse oximeter was in use, and oxygen saturation (HbO2) was measured by CO-oximetry.

Main results: There was no significant difference between SpO2 (94.6 +/- 5.4%) and HbO2 (94.9 +/- 5.1%) (P = .495, beta less than .2). There was a strong correlation between SpO2 and HbO2 (r = .898). The bias between SpO2 and HbO2 was -0.3, with a precision of 2.4. When SpO2 was 88% or more, HbO2 was 90% or more in every case. Mean carboxyhemoglobin was 1.3 +/- 0.9%, and mean methemoglobin was 0.9 +/- 0.3%. There was no significant difference between the pulse oximeter heart rate and the ECG heart rate (P = .223, beta less than .2).

Conclusion: We conclude that pulse oximetry is sufficiently accurate to be useful in the field when SpO2 is more than 88%. It is potentially useful in patients with clinical signs of acute hypoxemia and in patients receiving interventions that may produce acute hypoxemia. Further work is needed to evaluate the accuracy of pulse oximetry in the settings of elevated carboxyhemoglobin, methemoglobin, and very low saturations.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Pressure
  • Carboxyhemoglobin / analysis
  • Cross-Sectional Studies
  • Electrocardiography
  • Emergency Medical Services / standards*
  • Evaluation Studies as Topic
  • Female
  • Heart Rate
  • Humans
  • Hypoxia / diagnosis
  • Male
  • Methemoglobin / analysis
  • Middle Aged
  • Oximetry / standards*
  • Oxygen / blood
  • Prospective Studies


  • Methemoglobin
  • Carboxyhemoglobin
  • Oxygen