PEDIATRICS Vol. 99 No. 5 May 1997, pp. 681-686 (doi:10.1542/peds.99.5.681)
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PEDIATRICS Vol. 99 No. 5 May 1997, pp. 681-686

Pulse Oximetry as a Fifth Pediatric Vital Sign

Received Apr 15, 1996; accepted Jun 28, 1996.

William R. Mower*, Carolyn Sachs*, Emily L. Nicklin*, and Larry J. BaraffDagger

From the UCLA Emergency Medicine Center and the Departments of * Medicine and Dagger  Pediatrics, UCLA School of Medicine, Los Angeles, California.

Purpose.  To determine the utility of pulse oximetry as a routine fifth vital sign in acute pediatric assessment.

Design.  Prospective study using pulse oximetry to measure oxygen saturation in children presenting to emergency department triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to discharge or admit each child. We measured changes in medical treatment and diagnoses initiated after the disclosure of pulse oximetry values.

Setting and Participants.  The study included 2127 consecutive children presenting to triage at a university emergency department.

Measurements.  Changes in select diagnostic tests: chest radiography, complete blood count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta -agonists, supplemental oxygen; and hospital admission and final diagnoses that occurred after disclosure of triage pulse oximetry values.

Results.  Of 305 children having triage pulse oximetry values less than 95%, physicians ordered second oximetry for 49, additional chest radiography for 16, complete blood counts for 7, arterial blood gas measurements for 4, spirometry for 2, and ventilation-perfusion scans for 2. Physicians ordered 39 new therapies for 33 patients, including antibiotics for 15, supplemental oxygen for 11, and beta -agonists for 8. Five patients initially scheduled for hospital discharge were subsequently admitted. Physicians changed or added diagnoses in 25 patients.

Conclusions.  Using pulse oximetry as a routine fifth vital sign resulted in important changes in the treatment of a small proportion of pediatric patients.

Key words: oximetry, vital signs, triage, oxygen saturation.




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