Contribution of routine pulse oximetry to evaluation and management of patients with respiratory illness in a pediatric emergency department

Ann Emerg Med. 1995 Jan;25(1):36-40. doi: 10.1016/s0196-0644(95)70352-7.


Study objective: To determine whether routine pulse oximetry in a pediatric emergency department can be used to identify patients with a low oxygen saturation (SaO2) that is unexpected on the basis of clinical evaluation.

Design: Prospective comparison of blinded, clinical evaluation by physicians with subsequent pulse oximetry readings.

Setting: Pediatric ED in an urban, university medical center.

Participants: A convenience sample of 368 patients presenting to the pediatric ED with respiratory illnesses.

Methods: The history, physical examination, pediatric ED management, and therapy were recorded. Based on clinical assessment, the physician was asked whether the patient had a low SaO2 (< or = 92%). Room-air pulse oximetry was then obtained, with subsequent treatment and management plans recorded.

Results: Clinical assessment had a sensitivity of 33%, specificity of 86%, negative predictive value of 85%, and positive predictive value of 35% for detecting children with low SaO2. Unexpected low SaO2 usually led to a change in patient management or disposition.

Conclusion: Clinical evaluation in a pediatric ED does not screen adequately for the detection of hypoxemia and should be supplemented by routine pulse oximetry in all patients with respiratory findings.

MeSH terms

  • Child
  • Emergency Service, Hospital
  • Humans
  • Hypoxia / diagnosis*
  • Hypoxia / etiology
  • Oximetry*
  • Predictive Value of Tests
  • Prospective Studies
  • Respiratory Tract Diseases / complications
  • Respiratory Tract Diseases / diagnosis
  • Respiratory Tract Diseases / physiopathology*
  • Respiratory Tract Diseases / therapy
  • Sensitivity and Specificity