Can a pulse oxygen saturation of 95% to 96% help predict further vital sign destabilization in school-aged children?

Abstract

To determine whether a peripheral capillary oxygen saturation (SpO2) of 95% to 96% should be considered “nonurgent” in school-aged children, as suggested by the Canadian Emergency Department Triage and Acuity Scale.School-aged children (6–12 years old) with a normal body temperature (36.5–37.4°C) who visited our department between September, 2014 and August, 2015 (n = 4556) were divided into 4 groups based on SpO2: group A: 99% to 100%; group B: 97% to 98%; group C: 95% to 96%; and group D: ≤94%. The heart rate (HR), respiratory rate (RR), and hospitalization rate were compared among the groups, and also between children with SpO2 95% to 96% and matched controls with SpO2 ≥97% (n = 280 each).Among 4556 eligible patients, groups A, B, C, and D comprised 2700 patients (59.3%), 1534 patients (33.6%), 280 patients (6.2%), and 42 patients (0.9%), respectively. The median (interquartile range [IQR]) RR significantly increased with decreasing SpO2 (23 [20–25], 24 [20–26], 24 [23–30], and 30 [24–40] breaths/min in groups A–D, respectively; P < .001). Similarly, the median (IQR) HR significantly increased with decreasing SpO2 (93 [83–104], 98 [87–110], 107 [93–119], and 121 [109–137] bpm, groups A-D, respectively; P < .001). Group D had the highest annual hospital admission rate (18 cases/42 patients, 42.9%). Further, the HR and RR differed significantly between the cases (107 [93–119] bpm; 24 [23–30] breaths/min) and controls (96 [86–106] bpm; 24 [20–28] breaths/min, respectively) (P < .001 and P = .02, respectively).An SpO2 of 95% to 96% among school-aged children should not be considered “nonurgent,” but rather a significant clinical situation that requires early review of HR and RR. Prompt interventions among this group of children will help prevent further destabilization of vital signs, which will, in turn, contribute to decreased healthcare costs.

<p>Sleep-disordered breathing and comorbidities: role of the upper airway and craniofacial skeleton</p>

“…In children, average daytime oxygen saturations ≥95% are considered normal, 19 and values below this seen acutely are associated with signs suggesting illness. 20 Overnight medians or means are typically ≥97% in infants 9 , 10 and children, 21 – 24 rarely dipping to less than 90% in sleep in typically developing children, 21 – 25 although lower minimum values are seen in normal infants. 10 Nocturnal oxygen desaturation (NOD) is not the norm in infants, children, or adults under the age of 60 years ( Table 1 ).…”

Oxygen saturation thresholds in managing sickle cell disease at US children's hospitals

“…[34][35][36] Even within the normoxemia range, children in the general population triaged at the ER with SpO 2 95%-96% compared to 97%-100% had more distress and hospitalization, although outcomes nonetheless remained worse for hypoxemia ≤94%. 37 Normoxemia SpO 2 95%−96% should therefore not be dismissed as nonurgent in a pediatric emergency, and could have implications for SCD when considering a cutoff higher than 95% versus ≥95%. A value such as more than 95% could alternatively be represented as ≥96% to improve clarity and minimize confusion.…”

Why Living with Pulmonary Arterial Hypertension Requires a Holistic Approach: A Patient and Clinician Perspective

“…Normal values for oxygen saturation tests using pulse oximeters are considered to be 95% or higher. However, in the pediatric setting, it has been suggested that the normal range (at standard altitude) should be considered to be between 97 and 100%, with values of 95% and 96% prompting further investigation to assess whether there is an underlying cause [ 6 , 7 ]. With regards to analyzing pulse oximeter test results, healthcare professionals should be aware that readings may be less accurate in people with dark skin versus light skin.…”