Pulse Oximetry in Children: How Accurate Is It, Really?
Ross PA, Newth CJ, Khemani RG
Pediatrics. 2014;133:22-29
Pulse oximetry equipment is largely calibrated using adult patients. This study represents a comprehensive attempt to gain information on the accuracy of pulse oximetry devices in infants and children across a large range of oxygen saturations, child ages, and skin colors. The gold standard with which the instruments were compared was arterial oxygenation readings obtained by arterial blood gas measurements.
The children were admitted to 5 US pediatric intensive care units (ICUs) in 2009 and 2010. All children had both pulse oximetry readings and arterial oxygen saturation readings taken at the same time, were younger than 18 years, and were intubated and mechanically ventilated. In addition to classification by demographic variables and diagnoses, children were also classified as to whether they had cyanotic congenital heart disease (CHD) or were admitted for acute respiratory failure.
Measurements were completed whenever the children had an arterial saturation value obtained. At that time, the bedside providers also recorded the patient's corresponding pulse oximetry reading, temperature, capillary refill time, most recent hemoglobin level, ventilator settings, and type or manufacturer of the pulse oximeter.
The investigators focused on several measurements, including the "mean bias" -- the average difference between the pulse oximetry reading and the arterial oxygen saturation reading, given that pulse oximetry overestimates oxygen saturation. They also evaluated the "local bias," which is the mean bias of the measurements within specific ranges (eg, 91%-95%). Finally, they calculated a measure of accuracy that combined bias, the precision of the instruments, and the number of samples obtained. An acceptable accuracy was defined as variation of 3% less.
Analyses accounted for disease category (respiratory or cardiac); patient sex, hemoglobin level, and temperature; ventilator settings; and manufacturer of oximeter and sensor.
Accuracy of Pulse Oximetry in Children
Ross PA, Newth CJ, Khemani RG
Pediatrics. 2014;133:22-29
Study Summary
Pulse oximetry equipment is largely calibrated using adult patients. This study represents a comprehensive attempt to gain information on the accuracy of pulse oximetry devices in infants and children across a large range of oxygen saturations, child ages, and skin colors. The gold standard with which the instruments were compared was arterial oxygenation readings obtained by arterial blood gas measurements.
The children were admitted to 5 US pediatric intensive care units (ICUs) in 2009 and 2010. All children had both pulse oximetry readings and arterial oxygen saturation readings taken at the same time, were younger than 18 years, and were intubated and mechanically ventilated. In addition to classification by demographic variables and diagnoses, children were also classified as to whether they had cyanotic congenital heart disease (CHD) or were admitted for acute respiratory failure.
Measurements were completed whenever the children had an arterial saturation value obtained. At that time, the bedside providers also recorded the patient's corresponding pulse oximetry reading, temperature, capillary refill time, most recent hemoglobin level, ventilator settings, and type or manufacturer of the pulse oximeter.
The investigators focused on several measurements, including the "mean bias" -- the average difference between the pulse oximetry reading and the arterial oxygen saturation reading, given that pulse oximetry overestimates oxygen saturation. They also evaluated the "local bias," which is the mean bias of the measurements within specific ranges (eg, 91%-95%). Finally, they calculated a measure of accuracy that combined bias, the precision of the instruments, and the number of samples obtained. An acceptable accuracy was defined as variation of 3% less.
Analyses accounted for disease category (respiratory or cardiac); patient sex, hemoglobin level, and temperature; ventilator settings; and manufacturer of oximeter and sensor.