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Published on: January 17, 2011
Initial ED oxygen saturation ≤90% increases the risk of a complicated hospital course in pediatric asthmatics
Jay D Fisher1, Rishika P Sakaria2, Korrina N Siddiqui1
1UNLV School of Medicine, Department of Emergency Medicine, United States of America.
Insights
Children with acute asthma requiring hospital admission and an initial room air pulse oximetry of 90% or less face a significantly higher risk of a complicated hospital course. This finding aids in predicting severe pediatric asthma exacerbations.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Outcomes Research
Background:
- Emergency physicians manage pediatric asthma admissions after initial treatment failure.
- Predicting complicated hospital courses in pediatric asthma is crucial for resource allocation and patient care.
Purpose of the Study:
- To investigate if initial room air pulse oximetry ≤90% increases the risk of a complicated hospital course in pediatric patients admitted for acute asthma.
Main Methods:
- Retrospective chart review of 244 children (ages 2-17) admitted for asthma from January to December 2017.
- Data extraction using a standardized form by trained personnel.
- Analysis of initial room air pulse oximetry and hospital course outcomes.
Main Results:
- Patients with initial pulse oximetry ≤90% had a 11.3 times higher relative risk of a complicated course.
- Mean initial pulse oximetry was 85% in complicated cases versus 93% in uncomplicated cases (p<0.005).
- 27% of admitted children required Pediatric Intensive Care Unit (PICU) admission.
Conclusions:
- Initial room air pulse oximetry ≤90% is a significant predictor of complicated hospital courses in pediatric asthma admissions.
- This finding can assist emergency physicians in risk stratification for pediatric asthma exacerbations.
Abstract:
Emergency physicians are responsible for admitting children with asthma who do not respond to initial therapy. We examined the hypothesis that an initial room air pulse oximetry ≤90% elevates the risk of a complicated hospital course in children who require admission with acute asthma.
Methods:
Charts of all patients ages 2 years-17 years admitted for asthma from January 2017 to December 2017 were reviewed. An explicit chart review was performed by trained data extractors using a standardized form.
Results:
A total of 244 children meeting inclusion criteria were admitted for asthma from the ED during the study period. All patients had an initial room air pulse oximetry documented. Sixty-five were admitted to PICU status (27%), and 179 (73%) were admitted to floor status. The relative risk of a complicated course in those patients presenting with a saturation of ≤90% was 11.3 (95% CI 3.9-32.6). The mean initial pulse oximetry on patients with a complicated course was 85% versus 93% for those without a complicated course (p < 0.005).
Conclusion:
Our data suggest that in pediatric asthmatics that require admission from the ED, those with pulse oximetry readings less than or equal to 90% on presentation are at higher risk of a complicated hospital course.
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