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Oxygen saturation plus other factors must be considered in bronchiolitis work up
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Infants with bronchiolitis with an artificially elevated pulse oximetry reading were less likely to be hospitalized or receive active hospital care for more than 6 hours compared with those with an unaltered oximetry reading, according to study findings in JAMA.
Suzanne Schuh, MD, FRCPC, of The Hospital for Sick Children in Toronto, and colleagues conducted the randomized study in infants aged 4 weeks to 12 months with bronchiolitis. Infants had either true (n=108) or altered (n=105) oximetry values displayed. Altered saturation values were 3 points higher, to a maximum of 100%.
One infant with a saturation of 86% was accidently enrolled in the true saturation group.
Infants in both groups had comparable disease severity; 13% presented with triage saturations less than 94%. The difference in mean oxygen saturations between the two groups was 1.6%.
Forty-one percent of children in the true oximetry group were hospitalized within 72 hours compared with 25% in the altered oximetry group. Controlling for experimental saturation level indicated no significant difference in hospitalizations between the two groups. Controlling for age, duration of respiratory distress, triage saturation, and initial Respiratory Distress Assessment Instrument score established an overall risk of 4 (95% CI, 1.8-9.6).
“Among infants presenting to a pediatric ED with mild to moderate bronchiolitis, those with an artificially elevated pulse oximetry reading were less likely to be hospitalized within 72 hours or receive active hospital care for more than 6 hours than those with unaltered oximetry readings. This suggests that oxygen saturation should not be the only factor in the decision to admit or discharge and may need to be reevaluated,” the researchers wrote.
“This study highlights the challenge of ED clinicians and primary care providers faced with therapeutic dilemmas without clear guidance from the literature,” Robert Vinci, MD, and Howard Bauchner, MD, said in an accompanying editorial. “In such cases, clinicians must rely on their clinical judgment and supporting laboratory data to develop a plan for an individual patient that is safe, efficient, cost-effective, and uses inpatient facilities appropriately.”
Disclosure: The researchers report no relevant financial disclosures.
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