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Pulse oximetry in discharge decision-making: a survey of emergency physicians

Published online by Cambridge University Press:  21 May 2015

Lance Brown  and
Bernard Dannenberg
Lance Brown*
Affiliation:
Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Bernard Dannenberg
Affiliation:
Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
*
Department of Emergency Medicine, A-108, Loma Linda University Medical Center and Children’s Hospital, 11234 Anderson St., Loma Linda CA 92354 USA; 909 558-4344, fax 909 558-4121,; [email protected]

Abstract

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Objectives:

Our primary objective was to describe the pulse oximetry discharge thresholds used by general and pediatric emergency physicians for well-appearing children with bronchiolitis and pneumonia, and to assess the related practice variability.

Methods:

This mail-in survey was conducted in August and September 2001 and included the 281 active members of the Pediatric Emergency Medicine Section of the American College of Emergency Physicians. The survey consisted of 2 case scenarios of previously healthy, well-appearing children: a 2-year-old with pneumonia and a 10-month-old with bronchiolitis. Respondents were asked about their years of experience, teaching load, percentage of children in their practice, whether they currently have a written departmental guideline at their institution, and the lowest pulse oximetry reading that they would accept and still discharge the patient directly home.

Results:

One hundred and eighty-two (65%) physicians answered the survey and met the inclusion criteria. The respondents’ median oximetry value and interquartile range (IQR) for the pneumonia and bronchiolitis cases were 93% (92%–94%) and 94% (92%–94%) respectively. With the exception of the 3 physicians practising >1000 metres above sea level, the responses by subgroups were similar.

Conclusions:

There does not yet exist a safe, clinically validated pulse oximetry discharge threshold. Emergency physicians from this study sample have a modest degree of practice variability in a self-reported pulse oximetry discharge threshold. Emergency physicians may use this data to compare their own practice with that reported by this group.

Keywords

pulse oximetrypractice guidelinepneumoniabronchiolitisemergency department
Type
Pediatric EM • Pédiatrie d’urgence
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 6 , November 2002 , pp. 388 - 393
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Mower, WR, Sachs, C, Nicklin, EL, Baraff, LJ.Pulse oximetry as a fifth pediatric vital sign. Pediatrics 1997;99:681–6.CrossRefGoogle ScholarPubMed
2.Brown, K, Terndrup, TE.Viral and bacterial pneumonia in children. In: Tintinalli, JE, Kelen, GD, Stapczynski, JS, editors. Emergency medicine: a comprehensive study guide. 5th ed. New York: McGraw–Hill Publishers; 2000. p. 813.Google Scholar
3.Fleisher, GR.Infectious disease emergencies. In: Fleisher, GR, Ludwig, S, Hennetig, FM, Ruddy, Rm, Silverman, BK, editors. Textbook of pediatric emergency medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 755.Google Scholar
4.Letourneau, MA, Schuh, S.Respiratory disorders. In: Barkin, RM, Caputo, GL, Jaffe, DM, Knapp, JF, Schaefermeyer, RW, Seidel, JS, editors. Pediatric emergency medicine: concepts and clinical practice. 2nd ed. St. Louis: Mosby Publishers; 1997. p. 1091.Google Scholar
5.Kou, M, Mayer, T.Pediatric asthma and bronchiolitis. In: Tintinalli, JE, Kelen, GD, Stapczynski, JS, editors. Emergency medicine: a comprehensive study guide. 5th ed. New York: McGraw-Hill; 2000. p. 822.Google Scholar
6.Beebe, SA, Heery, LB, Magarian, S, Culberson, J.Pulse oximetry at moderate altitude: healthy children and children with upper respiratory infection. Clin Pediatr 1994;33:329–32.Google Scholar
7.Thilo, EH, Park-Moore, B, Berman, ER, Carson, BS.Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? Am J Dis Child 1991;145(10): 1137–40.Google Scholar
8.Nichols, R, Yaron, M, Reeves, J.Oxygen saturation in children living at moderate altitude. J Am Board Fam Pract 1993;6:452–6.Google Scholar
9.Pett, MA.Nonparametric statistics for health care research: statistics for small samples and unusual distributions. Thousand Oaks (CA): Sage Publications; 1997.Google Scholar
10.Gaddis, GM, Gaddis, ML.Introduction to biostatistics: Part 2. Descriptive statistics. Ann Emerg Med 1990;19(3):309–15.Google Scholar
11.Lee, WW, Mayberry, K, Crapo, R, Jensen, RL.The accuracy of pulse oximetry in the emergency department. Am J Emerg Med 2000;18:427–31.Google Scholar
12.Sinex, JE.Pulse oximetry: principles and limitations. Am J Emerg Med 1999;17:59–67.Google Scholar
13.Soubani, AO.Noninvasive monitoring of oxygen and carbon dioxide. Am J Emerg Med 2001;19:141–6.Google Scholar
14.Rosen, LM, Yamamato, LG, Wiebe, RA.Pulse oximetry to identify a high-risk group of children with wheezing. Am J Emerg Med 1989;7:567–70.Google Scholar
15.Mower, WR, Sachs, C, Nicklin, EL, Safa, P, Baraff, LJ.Effect of routine emergency department triage pulse oximetry screening on medical management. Chest 1995;108:1297–302.Google Scholar
16.Mayefsky, JH, El-Shinaway, Y.The usefulness of pulse oximetry in evaluating acutely ill asthmatics. Pediatr Emerg Care 1992;8: 262–4.Google Scholar
17.Maneker, AJ, Petrack, EM, Krug, SE.Contribution of routine pulse oximetry to evaluation and management of patients with respiratory illness in a pediatric emergency department patient. Ann Emerg Med 1995;25:36–40.Google Scholar
18.Roback, MG, Baskin, MN.Failure of oxygen saturation and clinical assessment to predict which patients with bronchiolitis discharged from the emergency department will return requiring admission. Pediatr Emerg Care 1997;13:9–11.Google Scholar
19.Keahey, L, Bulloch, B, Becker, AB, Pollack, CV, Clark, S, Carmargo, CA.Initial oxygen saturation as a predictor of admission in children presenting to the emergency department with acute asthma. Ann Emerg Med 2002;40:300–7.CrossRefGoogle Scholar
20.Kublick, RM.Pulse oximetry. Am J Emerg Med 1987;3:127–30.Google Scholar