CONTRIBUTION OF ROUTINE PULSE OXIMETRY TO EVALUATION AND MANAGEMENT OF PATIENTS WITH RESPIRATORY ILLNESS IN A PEDIATRIC EMERGENCY DEPARTMENT

被引:21
作者
MANEKER, AJ
PETRACK, EM
KRUG, SE
机构
关键词
D O I
10.1016/S0196-0644(95)70352-7
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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 (less-than-or-equal-to 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.
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页码:36 / 40
页数:5
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[1]  
Simpson, Flenley, Arterial blood gas tensions and pH in acute lower respiratory tract infections in infancy and childhood, Lancet, 1, pp. 7-12, (1967)
[2]  
Hurwitz, Burney, Howatt, Clinical scoring does not accurately assess hypoxemia in pediatric asthma patients, Ann Emerg Med, 13, pp. 1040-1043, (1984)
[3]  
Hall, Hall, Speers, Clinical and physiological manifestations of bronchiolitis and pneumonia: Outcome of respiratory syncytial virus, Am J Dis Child, 133, pp. 798-802, (1979)
[4]  
Wang, Milner, Navas, Et al., Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections, Am Rev Respir Dis, 145, pp. 106-109, (1992)
[5]  
Taylor, Whitwam, The accuracy of pulse oximeters, Anaesthesia, 43, pp. 229-235, (1988)
[6]  
Yelderman, New, Evaluation of pulse oximetry, Anesthesiology, 59, pp. 349-352, (1983)
[7]  
Bowes, Corke, Hulka, Pulse oximetry: A review of the theory, accuracy and clinical applications, Obstet Gynecol, 74, pp. 541-546, (1989)
[8]  
Mihm, Halperin, Noninvasive detection of profound arterial desaturations using a pulse oximetry device, Anesthesiology, 62, pp. 85-87, (1985)
[9]  
Tyler, Tantisira, Winter, Et al., Continuous monitoring of arterial oxygen saturation with pulse oximetry during transfer to recovery room, Anesth Analg, 64, pp. 1108-1112, (1985)
[10]  
Cote, Goldstein, Cote, Et al., A single blind study of pulse oximetry in children, Anesthesiology, 68, pp. 184-188, (1988)