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Original Investigation |

Effect of Oximetry on Hospitalization in Bronchiolitis:  A Randomized Clinical Trial

Suzanne Schuh, MD, FRCPC1,2; Stephen Freedman, MD, FRCPC3; Allan Coates, MD2; Upton Allen, MD, FRCPC1,2; Patricia C. Parkin, MD, FRCPC1,2; Derek Stephens, MSc2; Wendy Ungar, PhD2; Zelia DaSilva, RT1; Andrew R. Willan, PhD2
[+] Author Affiliations
1Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
2Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
3Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada
JAMA. 2014;312(7):712-718. doi:10.1001/jama.2014.8637.
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Importance  Routine use of pulse oximetry has been associated with changes in bronchiolitis management and may have lowered the hospitalization threshold for patients with bronchiolitis.

Objective  To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed.

Design, Setting, and Participants  Randomized, double-blind, parallel-group trial conducted from 2008 to 2013 in a tertiary-care pediatric emergency department in Toronto, Ontario, Canada. Participants were 213 otherwise healthy infants aged 4 weeks to 12 months with mild to moderate bronchiolitis and true oxygen saturations of 88% or higher.

Interventions  Pulse oximetry measurements with true saturation values displayed or with altered saturation values displayed that have been increased 3 percentage points above true values.

Main Outcomes and Measures  The primary outcome was hospitalization within 72 hours, defined as inpatient admission within this interval or active hospital care for greater than 6 hours. Secondary outcomes included the use of supplemental oxygen in the emergency department, level of physician agreement with discharge from the emergency department, length of emergency department stay, and unscheduled visits for bronchiolitis within 72 hours.

Results  Forty-four of 108 patients (41%) in the true oximetry group and 26 of 105 (25%) in the altered oximetry group were hospitalized within 72 hours (difference, 16% [95% CI for the difference, 3.6% to 28.4%]; P = .005). Using the emergency department physician as a random effect, the primary treatment effect remained significant (adjusted odds ratio, 4.0 [95% CI, 1.6 to 10.5]; P = .009). None of the secondary outcomes were significantly different between the groups. There were 23 of 108 (21.3%) subsequent unscheduled medical visits for bronchiolitis in the true oximetry group and 15 of 105 (14.3%) in the altered oximetry group (difference, 7% [95% CI, −0.3% to 0.2%]; P = .18).

Conclusions and Relevance  Among infants presenting to an emergency department with mild to moderate bronchiolitis, those with an artificially elevated pulse oximetry reading were less likely to be hospitalized within 72 hours or to 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, and its use may need to be reevaluated.

Trial Registration  clinicaltrials.gov Identifier: NCT00673946

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Enrollment, Randomization, and Follow-up of Pulse Oximetry in Infant Bronchiolitis Trial

aThe follow-up at 72 hours was carried out in patients discharged at the index visit (82 in true oximetry group, 89 in altered oximetry group). A total of 26 and 16 patients were remaining in hospital at the time of follow-up in the true and altered oximetry groups, respectively.

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