Oxygen readings sway decision to hospitalize infants with bronchiolitis

1. Among infants with mild to moderate bronchiolitis presenting to the emergency department (ED), artificially elevating pulse oximetry readings reduced hospitalizations significantly compared to infants with unaltered pulse oximetry readings. 

2. The length of ED stay, supplemental oxygen use in the ED, physician level of agreement with discharge from ED and the rates of unscheduled visits for bronchiolitis was not significant lydifferenct between the two groups of infants. 

Evidence Rating Level: 1 (Excellent)       

Study Rundown: Bronchiolitis is responsible for the majority of infant hospitalizations. Pulse oximetry is the standard method of gauging oxygen saturation, a clinical variable postulated to affect the management of patients with bronchiolitis. Previous studies have demonstrated that pulse oximetry may affect hospitalizations although none have focused on the ED patient population.

This study examined infants with bronchiolitis in the pediatric ED and compared outcomes in patients with pulse oximetry displaying true oxygen saturation values with pulse oximetry displaying oxygen saturation 3 percentage points above the true value. The primary outcome measured was hospitalization within 72 hours, defined as admission within this timeframe or hospital care for more than 6 hours. The true oximetry group had a higher percentage of patients hospitalized, a statistically significant finding.

This study was limited by a high number of refusals to participate, potentially contributing to selection bias, as well as a limited sample of subjects with low oxygen saturation readings and the study being performed at a single center. Future studies may be multi-site to make results more generalizable and study infants with low oxygen saturations to determine the optimal threshold for oxygen supplementation and hospitalization. Nevertheless, this study demonstrates that physiologically minor changes in oxygen saturation had major implications on hospitalization decisions. This suggests that the management of bronchiolitis should be based on clinical factors other than oxygen saturation, such as degree of respiratory distress and hydration status.

Click to read the study, published today in JAMA

Click to read the editorial, published today in JAMA

Relevant Reading: Bronchiolitis: recent evidence on diagnosis and management

In-Depth [randomized controlled trial]: This study was a randomized, double-blind trial in which infants with bronchiolitis were randomized to either the true oximetry reading group (n=108) or the altered oximetry reading group (n=105). The study was performed at a tertiary-care pediatric ED and included previously healthy infants aged 4 weeks to 12 months diagnosed with bronchiolitis and with true saturations above 88%. 41% (44/108 patients) of the true oximetry group was hospitalized within 72 hours compared to 25% (26/105 patients) of the altered oximetry group (16% difference [95% CI for difference, 3.6% to 28.4%]; p = .005). The secondary outcomes of length of ED stay, supplemental oxygen use in the ED, physician level of agreement with discharge from ED and the rates of unscheduled visits for bronchiolitis had no significant difference between the two groups.

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