Contribution of Routine Pulse Oximetry to Evaluation and Management of Patients With Respiratory Illness in a Pediatric Emergency Department

Maneker, Amy J; Petrack, Emory M.; Krug, Steven E.

doi:10.1016/s0196-0644(95)70352-7

Cited by 27 publications

(21 citation statements)

References 11 publications

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“…The assessment of RR is also a useful tool for the recognition of lower airway disease when used by inexperienced health workers [32, 33]. However, for the clinical assessment of the severity of wheezy disorders in young children, additional information is needed [34, 35]. Clinical evaluation including RR does not screen adequately for the detection of hypoxemia and should therefore be supplemented by routine pulse oximetry in young children with wheezy disorders [35].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants

Wildhaber

Dore²,

Devadason³

et al. 2002

Respiration

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Objectives: The aim of this study was to compare subjective measures (overall health assessment both by the study physician and the child’s mother) with objective measurements of forced expiratory volumes (FEV_t) and maximal flow at functional residual capacity v̇_maxFRC) in recurrently wheezy infants. Methods: Sixteen wheezy infants (12 boys) aged 8–26 months were studied. A clinical assessment at visit 1 was followed by the run-in period during which day- and nighttime asthma symptom scores were obtained. The actual study period consisted of 2 visits when patient’s lung function was assessed. The first of which was during an acute exacerbation (visit 2), while the second was when the infant was asymptomatic (visit 3). FEV_t were obtained by the raised volume rapid thoracic compression technique (RVRTC) and v̇_maxFRC by the tidal volume rapid thoracic compression technique (TVRTC). Results: Mean FEV_t but not mean v̇_maxFRC were significantly lower at visit 2 compared to visit 3 (FEV_0.5: p = 0.005, and FEV_0.75: p = 0.002; v̇_maxFRC: p = 0.15) and correlated well with overall health assessment by the study physician (FEV_0.5: r = 0.82, and FEV_0.75: r = 0.84), but not with the overall health assessment by the mother. Conclusions: We have shown in the present study that objective measurements of FEV_t from a raised lung volume correlate well with the overall health assessment by the study physician; this was in contrast to measurements of v̇_maxFRC in the tidal volume range. We therefore conclude that the RVRTC technique is a feasible method to assess and monitor obstructive lung disease in infancy.

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Section: Discussionmentioning

confidence: 99%

Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants

Wildhaber

Dore²,

Devadason³

et al. 2002

Respiration

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“…Seven infants were subsequently withdrawn because squamous epithelial cell contamination exceeded 20% of total cell count. A total of 37 infants (male:female ratio: 2.08) with a median (interquartile) age of 17 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) wk were included, with a median duration of symptoms before admission of 3 (2-5) days, and median SaO 2 of 93 (91-95)%. Five (13.5%) had atelectasis on chest X-ray and 17 (46%) had familial history of atopy or asthma.…”

Section: Resultsmentioning

confidence: 99%

“…The oxygen saturation value was recorded when the displayed wave of pulse monitoring was stabilized for at least 1 min. SaO 2 £ 92% was considered a criterion of severity (22). In addition, the necessity of enteral or parenteral feeding, and the length of hospitalization were assessed as severity criteria (23).…”

Section: Study Design Patients and Methodsmentioning

confidence: 99%

Neutrophil but not eosinophil inflammation is related to the severity of a first acute epidemic bronchiolitis in young infants

Marguet

Bocquel

Bénichou

et al. 2007

Pediatric Allergy Immunology

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Acute bronchiolitis is the main cause of emergency visits and hospitalizations in infants. Recent data suggest that neutrophil- and eosinophil-mediated inflammations were part of bronchiolitis pathophysiology. Apart from the defined risk factors, few was known on the underlying pathophysiology, which might point out the differences observed in the severity of the disease. The aim of this study was to assess whether the clinical severity of acute epidemic bronchiolitis in young infants might be related to a specific underlying inflammatory process. Total and differential cell counts, IL-8, eotaxin, eosinophil cationic protein (ECP) and albumin levels were assessed at the time of admission in bronchial secretions from 37 infants (median age 17 wk) with acute bronchiolitis. Outcome severity variables were: hypoxemia, Silverman score, tachypnea, feeding alteration, and duration of hospitalization. Neutrophils predominated, and eosinophils were present in 54% of the infants. IL-8 levels strongly correlated with ECP and albumin levels. Albumin levels were correlated with ECP and eotaxin levels. IL-8 levels were higher in infants with hypoxemia and inversely related with SaO(2) levels. IL-8 and albumin levels significantly rose with respiratory rate, and Silverman score. IL-8, albumin and ECP levels were significantly higher in infants hospitalized >/=7 days. Furthermore, IL-8 levels were correlated with the duration of hospitalization. Neither cell counts nor eotaxin levels were related to the severity criteria studied. This study suggests that IL-8-associated airway inflammation significantly contributed to the severity of acute epidemic bronchiolitis.

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“…The routine availability of pulse oximetry in the ED, for instance, could result in additional diagnostic workups for patients with abnormal findings. 19 The differences in lengths of stay observed may not have been entirely due to differences in the medical decision-making process. The queuing rules and other differences in clerical and nursing staffing may have contributed to the more rapid management of FT patients.…”

Section: Hampers Et Al • Fast Track and Pediatric Edmentioning

confidence: 96%

Fast Track and the Pediatric Emergency Department: Resource Utilization and Patient Outcomes

Hampers

Cha

Gutglass

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: To examine differences in the evaluation, management, and outcomes for patients seen in an on-site ''fast track'' (FT) vs the main ED. Methods: Over a three-month period, patients presenting to an urban pediatric ED were prospectively assessed. Patients included were: triaged as ''nonurgent''; aged 2 months to 10 years; not chronically ill; and had fever, or complaint of vomiting, diarrhea, or decreased oral intake. Evening and weekend care was provided in the FT; at all other times these low-acuity patients were seen in the ED. Seven days after the visit, families were interviewed by telephone. Results: Four hundred seventy-nine and 557 patients were seen in the FT and ED, respectively. The patients in the two settings did not differ in age, clinical condition, race, or commercial insurance status. Patient mean test charges were $27 and $52 for the FT and ED, respectively (p < 0.01). Twenty-four percent of the FT patients vs 41% of the ED patients had tests performed (p < 0.01). Average length of stay was 28 minutes shorter in the FT (95% CI = 19 to 36, p < 0.01). Follow-up was completed for 480 of 755 families with telephones (64%). The FT and ED patients did not differ at follow-up: 90% vs 88% had improved conditions (p = 0.53), 18% vs 15% had received unscheduled follow-up care (p = 0.44), and 94% of the families in both groups were satisfied with the visit (p = 0.98). Conclusions: Compared with those in the main ED, the study patients seen in the FT had fewer tests ordered and had briefer lengths of stay. These findings were not explained by differences in patient ages, vital signs, or demographic characteristics. No difference in final outcomes or satisfaction was detected among the families contacted for follow-up. Key words: fast track; resource utilization; outcomes; urgent care. ACADEMIC EMERGENCY MEDICINE 1999; 6:1153-1159 M ANY URBAN pediatric EDs provide care for a large number of nonemergent, ambulatory patients, particularly during the winter season.1,2 Assessment and management of these children may strain resources and increase waiting times for all patients. In response, many EDs have established on-site alternative locations to facilitate care of these nonacute cases, thus increasing capacity in the general ED for more acute or complicated patients.3-5 These units are often staffed by experienced practitioners, who manage a large volume of patients rapidly.6 As such, they are commonly known as ''fast tracks'' (FTs) or ''urgent care'' units. Fast tracks have been shown to decrease waiting times, and are generally regarded as a more efficient alternative to the main ED for care of uncomplicated patients with low-acuity concerns. 7,8 What has not been well-studied, however, are the differences in care provided in these settings. Specifically, it is unclear whether such patients are investigated and managed differently than they would have been in the main ED, and more important, whether such differences affect patient outcomes.We undertook this study to determine whether the...

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Contribution of Routine Pulse Oximetry to Evaluation and Management of Patients With Respiratory Illness in a Pediatric Emergency Department

Cited by 27 publications

References 11 publications

Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants

Comparison of Subjective and Objective Measures in Recurrently Wheezy Infants

Neutrophil but not eosinophil inflammation is related to the severity of a first acute epidemic bronchiolitis in young infants

Fast Track and the Pediatric Emergency Department: Resource Utilization and Patient Outcomes

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